bluuebunny/crossref_metadata_2025 huggingface dataset:
Folate and Vitamin B12Levels in an Urban Elderly Population With Chronic Diseases
Authors: Grinblat Joseph , Marcus David L. , Hernandez Francisco , Freedman Michael L.
Published: April 2015

Folate levels of serum and red blood cells (RBC) and vitamin B12 serum levels were investigated in 326 urban chronically ill elderly ambulatory patients and 41 healthy young control subjects. Two laboratory methods were used for investigating the folate levels, the microbiologic assay (MBA) with Lactobacillus casei and radioassay (RA). Serum and RBC samples of 326 patients were tested by the folate MBA and 270 of the same samples by the RIA methods. In the MBA 6.8% of the patients and 12.2% of controls had low levels of folate RBC (less than 200 nglmL) and 1.8% of patients and 4.8% of controls had low serum folate levels (less than 5 ng/mL). All of the patients with the low folate levels had normal hematologic findings and no clinical symptoms of folate deficiency. In the RIA method, all of the patients and almost all of the control subjects (except one) had normal folate levels. Ten of the patients (3%) had low levels of serum vitamin (less than 200 pg/mL). They were hematologically normal. They had normal Schilling tests and normal vitamin B12 dietary intake. Their RBC folate levels were normal and even somewhat higher. Forty percent of these patients had macular degeneration of the eyes. The data indicate the superiority of the RA method over the MBA and bring into question the accuracy of previous studies. The data furnish further evidence that a low vitamin B12 level in the elderly is not necessarily a true vitamin B12deficiency and raise the possibility of an association between low B12 serum levels and macular degeneration of the eyes.
Psychiatric Emergency Consultations to Elderly Patients in a Canadian General Hospital
Authors: Pérez Edgardo L. , Blouin Jane
Published: April 2015

The authors compared the demographic and clinical characteristics and treatment recommendations for elderly (greater than or equal to 60 years) and younger patients (17 to 59 years) seen for an emergency psychiatric consultation in a teaching general hospital. Findings revealed 11 distinctive characteristics that differentiated elderly from younger patients. Most notably, the elderly experienced their chief complaint for a longer time before referral to the emergency room by their primary care physician and had higher prevalence of affective disorders and psychologic factors affecting physical condition. Some of the implications of these results are discussed with the view to planning psychiatric services for the elderly and education programs.
Earlier Psychiatric Morbidity in Patients With Alzheimer's Disease
Authors: Agbayewa M. Oluwafemi
Published: April 2015

The medical charts of 188 Alzheimer patients and a comparison group of 80 nondemented patients matched for age and sex were retrospectively reviewed for history of psychiatric morbidity. The Alzheimer patients were more likely to have had a psychiatric illness earlier in life (χ2 = 8.5238, df = 1, P < .001) with unipolar depression and paranoid disorder being the two most frequent psychiatric disorders. Possible explanations for these findings include underreporting, facility bias, functional psychiatric features as prodromal states of Alzheimer's disease, and vulnerability to psychiatric morbidity in those who go on to develop Alzheimer's disease. The likelihood of each of these explanations is discussed.
Impact of Medicare Diagnosis‐Related Groups (DRGs) on Nursing Homes in the Portland, Oregon Metropolitan Area
Authors: Lyles Yvonne M.
Published: April 2015

To evaluate the impact of the Medicare Prospective Payment System (PPS) on nursing homes, resident census and staffing data from 78 Portland, Oregon nursing homes were compiled from annual reports filed with the state. Between fiscal years (FYs) 1983 and 1984, (before and after initiation of the Medicare PPS), there was no significant change in the total number of patient‐days, but there was a 20.5% increase in the total number of deaths and a significant increase in average facility adjusted death rates (P = .004). Between the previous FYs 1982 and 1983, the total number of deaths had risen only 8.3%, and the average facility adjusted death rate had no significant change. Since initiation of diagnosis‐related groups (DRGs), these nursing homes also made sizeable increases in their adjusted full‐time registered nurse employment rate, and reported fewer patients reimbursed by Medicare.

These same nursing homes were surveyed in spring, 1985 to determine the impact of Medicare DRGs in more qualitative terms. Of the 51 nursing homes (66%) responding, more than half reported increased severity of illness, shorter length of stay, increased prevalence of clinical problems, and increased use of medical supplies. In addition, more than half of the respondents reported increased frequency of requests for Friday and weekend admissions, admission of patients too sick for the facility, and physician phone consultation.

These findings indicate that Portland, Oregon nursing homes experienced increased patient severity of illness, explained at least in part by earlier hospital discharge, following DRGs.
Pernicious Anemia in the Demented Patient Without Anemia or Macrocytosis
Authors: Gross Joel S. , Weintraub Nancy T. , Neufeld Richard R. , Libow Leslie S.
Published: April 2015

It is well known that the neurologic manifestations of vitamin B12 deficiency can occur in the absence of anemia. The authors recently observed two elderly patients who presented to a chronic care institution with the diagnosis of dementia, and in both individuals low serum B12 levels were found in conjunction with abnormal Schilling tests. In neither of these two patients was there anemia or macrocytosis. After receiving parenteral B12 injections there was improvement noted in cognitive functions as well as in activities of daily living. The authors are reporting these patients to alert clinicians to the fact that pernicious anemia in the elderly can first present with low serum B12 levels and neurologic abnormalities in the absence of anemia or macrocytosis.
Relevance of Readmission of Elderly Patients Discharged From a Geriatric Unit
Authors: Andrews Keith
Published: April 2015

Eight percent of the elderly patients discharged from a geriatric unit in one year were readmitted within three months. Forty‐six percent had been living alone and nearly all of these had received full community support at the time of discharge. Recurrent problems were the reason for readmission in 59% of cases, mainly due to falls, incontinence, and confusion. Only 54% of the readmitted patients were discharged home again—those with new additional problems tended to die in hospital, whereas those with recurrent problems often required institutional long‐term care. It is concluded that even with careful discharge planning, a proportion of patients will require readmission, some of which will also require long‐term institutional care. This number is quite small in terms of the total number of patients discharged from a geriatric unit and should not be a reason for seeking nursing home care at an early stage.
Dementia of the Alzheimer Type
Authors: Cummings Jeffrey L. , Benson D. Frank
Published: April 2015

An Inventory presenting characteristics useful in the clinical identification of dementia of the Alzheimer type (DAT) is presented. The Inventory includes aphasia, amnesia, abnormal cognition and visuospatial skills, inappropriate lack of concern, and normal motor functions. In a retrospective study of 50 consecutive dementia patients, the DAT Inventory correctly identified 100% of DAT subjects and 94% of non‐DAT cases. Utilization of positive criteria can aid in the identification of DAT and can facilitate recognition of treatable illnesses masquerading as DAT.
Stressing the Postural Response
Authors: Wolfson L. I. , Whipple R. , Amerman P. , Kleinberg A.
Published: April 2015

Using a series of graded destabilizing forces, we have developed a simple quantitative test of the postural response: the Postural Stress Test (PST). Suitable for widespread testing of elderly subjects, the test evaluates the subject's ability to avoid a fall as well as the appropriateness of the response. We have determined that by comparison with young subjects, the elderly controls have compromised although functionally effective balance. On the other hand, the balance response was severely compromised in half of the individuals with a history of falls. Experience with the Postural Stress Test suggests it will predict those elderly individuals with a tendency to fall as well as provide a simple mechanism for studying the balance response in the elderly.
Validation of the Functional Assessment Inventory Against a Multidisciplinary Home Care Team
Authors: Robinson Bruce E. , Lund Christine A. , Keller Donald , Cuervo Colleen A.
Published: April 2015

Systematic multidimensional assessment techniques such as the Functional Assessment Inventory (FAI) are increasingly used with the elderly for outcome measurement, prediction of service needs, and accurate description for comparative purposes. The FAI is a structured interview followed by a rating process which compares patient status against standard descriptive phrases. Patients are assessed in five areas: mental health, physical health, social resources, economic resources, and activities of daily living (ADD. The validity of the FAI was tested by comparing ratings of patient health obtained by a single investigator using only the instrument with ratings obtained by consensus from an interdisciplinary home care team providing long‐term care for the patients studied. An excellent level of agreement (weighted kappas from .583 to .780) was found in all areas studied. A single significant difference in ADL rating with a high correlation coefficient (r = .85) was interpreted as due to a difference between the single rater and the team in the definition of ADL. The ease of obtaining summary ratings from clinical personnel suggests that further exploration of this rapid quantification of patient health is warranted.
Dementia of the Alzheimer's Type and Depression
Authors: Reifler Burton V. , Larson Eric , Teri Linda , Poulsen Marilyn
Published: April 2015

This retrospective review of medical records was designed to address three questions: 1) Can the depression seen in some patients with Dementia of the Alzheimer's Type (DAT) be successfully treated? 2) Does this treatment lead to any long‐term improvement in the patient's cognitive status? and 3) Do patients with coexisting DAT and depression have a different long‐term clinical course than nondepressed DAT patients? In the authors' sample of 131 DAT subjects, 41 (31%) also met DMS‐III criteria for a major affective disorder. Of those DAT plus depression patients whose records reflected treatment (usually with a tricyclic antidepressant), 85% (17 of 20) showed clear evidence of improvement in mood, vegetative signs, or activities of daily living (ADLs) based on review of the medical record. An analysis of change in cognitive function (measured by the Folstein Mini‐Mental State) and five global measures failed to reveal any differences between the depressed and nondepressed groups after a mean interval of 17 months. The depression that occurs in approximately one‐quarter to one‐third of DAT patients appears to respond to appropriate therapy. These patients often show improvement in their mood and ADLs but remain demented.
Age at Onset and Rate of Progression of Alzheimer's Disease
Authors: Huff F. Jacob , Growdon John H. , Corkin Suzanne , Rosen T. John
Published: April 2015

Age at onset, duration, and severity of dementia were evaluated in 165 patients with a clinical diagnosis of Alzheimer's disease. Rate of progression of dementia was determined in 77 patients by repeated administration of the Blessed Dementia Scale (BDS). The distribution of age onset among patients was bimodal, with a division at about age 65. Duration of dementia at the time of initial examination was shorter, and rate of progression on follow‐up examination was more rapid in senile‐onset (age 65 or greater) than in presenile‐onset (before age 65) cases. Considerable overlap among values for the two patient groups was observed for both variables, indicating that age at onset is not a strong predictor of rate of progression of dementia in patients with Alzheimer's disease.
Nutritional Status and Dietary Intake in Institutionalized Patients With Alzheimer's Disease and Multiinfarct Dementia
Authors: Sandman Per‐Olof , Adolfsson Rolf , Nygren Charlotte , Hallmans Goran , Winblad Bengt
Published: April 2015

Nutritional status, dietary intake, weight change, and mortality were studied in a sample of severely demented, institutionalized patients. Dietary intake was registered during five days in two periods, five weeks apart. A weighing method was used. Nutritional status was assessed by anthropometric measurements (weight for height index, triceps skinfold thickness, arm muscle circumference) and determination of circulating proteins (albumin, transferrin, and prealbumin).

Energy and/or protein malnutrition was found in 50% of the patients. The mean dietary intake was sufficient according to energy (2059 kcallday), proteins, vitamins, and minerals. A comparison of patients with or without malnutrition showed no differences in dietary intake, diagnoses, age, length of hospital stay, or duration of illness. However, malnourished patients had had four times as many infectious periods treated by antibiotics as patients with no malnutrition. Thirty‐nine of 44 patients lost weight during their hospital stay. There was no correlation between loss of weight, length of hospital stay, or duration of illness.
Low Serum Testosterone and Myocardial Infarction in Geriatric Male Inpatients
Authors: Swartz Conrad M. , Young Mark A.
Published: April 2015

A survey of serum testosterone levels and a range of medical and behavioral factors was conducted on 71 males aged 46 to 89 years in an extended care medical facility. Histories of myocardial infarction or heavy drinking were separately associated with diminished testosterone levels (P < .002 and P < .006, respectively). No other factor was associated with testosterone level, including age and mobility. A testosterone level of no more than 438 ng/dl best discriminated patients with myocardial infarction (P < .005, sensitivity 86.2%, and selectivity 50%). Increased incidence of myocardial infarction appeared to be influenced by testosterone in a threshold manner, since the incidence did not rise further with lesser testosterone levels once the level was below 438 ngldl. The incidence of myocardial infarction among patients with testosterone levels below this threshold was unaffected by their exposure to alcohol. Among the 21 formerly heavy drinkers, many (62%) showed testosterone levels ≤300 ngldl. Formerly heavy drinkers should be routinely considered for serum testosterone determination.
Antecedents of Death in the Men of a Veterans Administration Nursing Home
Authors: Rudman Daniel , Mattson Dale E. , Nagraj Hoskote S. , Caindec Norma , Rudman Inge W. , Jackson Daniel L.
Published: April 2015

This study aims to learn whether the annual clinical and laboratory screening of nursing home residents provides significant information about their chance of dying during the following year.

In August 1984, a comprehensive clinical data base was compiled for 176 male residents of this VA nursing home. During the next 14 months, 12 men were discharged to other locations and were dropped from the study; among the remaining 166, who comprised the study group of this report, 24 died. The most common immediate causes of death were infections (67%) and cardiac disorders (25%). Twenty of the deaths occurred after transfer to the acute hospital services.

Among the 67 items in the clinical data base (including absence or presence of 17 diagnoses and 16 drugs), eight were significantly correlated with death rate. Age and functional impairment were directly related, and inversely related were the following: body weight as percent of ideal, triceps skin fold, hematocrit, hemoglobin, serum albumin, and serum cholesterol. Multivariate analysis showed cholesterol and hematocrit to be the most informative of the eight mortality predictors and to correlate with death independently of age and functional level.

Subgroups defined on the basis of combinations of mortality‐related attributes differed many fold in their death rates. For example, men with cholesterol ≤ 256 mg/dl and hematocrit ≤ 41% died at a rate 42 times the rate of men with values above both thresholds.

For each mortality‐related attribute, death rate varied with the level of the attribute. This relationship extended into the generally accepted “normal ranges” for cholesterol, hematocrit, hemoglobin, and albumin.
Clinical Features of Pulmonary Tuberculosis in Young and Old Veterans
Authors: Katz Paul R. , Reichman William , Dube David , Feather John
Published: April 2015

Pulmonary tuberculosis (TB) continues to pose a health threat to the elderly population. In order to delineate age‐related differences in disease presentation a comparison between young and old male veterans hospitalized over a five‐year period with culture proven Mycobacterium tuberculosis is reported. The study sample included 27 patients 60 years of age and older (range, 60 to 85; mean, 70) and 52 patients under 60 years of age (range, 22 to 59; mean, 51). The elderly were significantly less likely to demonstrate cavitary lesions on admission radiographs or present with hemoptysis but were more likely to present with right lower lobe infiltrates and complaints of dyspnea. Symptoms prior to admission occurring with equal frequency in both young and old subjects included fever, anorexia, weight loss, and cough. Although treatment was delayed in the elderly, there were no age‐related differences in mortality. Skin testing was underutilized in all patients regardless of age. The results support the notion that the clinical presentation of pulmonary TB is remarkably similar in young and old males.
Prevalence of Thyroid Disorders in Psychogeriatric Inpatients A Possible Relationship of Hypothyroidism with Neurotic Depression but not with Dementia
Authors: Tappy L. , Randin J. P. , Schwed P. , Wertheimer J. , Lemarchand‐Béraud Th.
Published: April 2015

Thyroid disorders are known to manifest occasionally as isolated psychiatric disorders. In order to determine whether thyroid dysfunctions could play a significant role in the pathogenesis of psychiatric disorders in the elderly, the prevalence of thyroid disorders was compared in a group of psychogeriatric patients and in a group of nonpsychiatric elderly patients.

Thyroid function screening was performed in 157 patients consecutively admitted to a psychogeriatric unit, and the prevalence of hypothyroidism was determined in the different groups of psychiatric disorders (senile and multi‐infarct dementia, organic brain syndrome of other etiologies, psychotic depression, neurotic depression, chronic delusional state, acute confusional state, and personality disorder). Thyroid function screening was performed similarly in 104 unselected elderly patients admitted to the medico‐surgical admission unit of the University hospital to assess the prevalence of hypothyroidism in a general, nonpsychiatric, elderly population.

Eight patients were diagnosed as hypothyroid based on an elevated basal thyrotropin (TSH) and on thyrotropin‐releasing hormone (TRH) test in the total number of patients, two in the nonpsychiatric and six in the psychiatric group. Three had clinical hypothyroidism, with decreased total and free T4 and T3 plasma levels in addition to increased basal TSH, five had biochemical hypothyroidism, with normal T4 and T3 levels and an excess TSH response to oral TRH. The prevalence of hypothyroidism in the two groups did not differ significantly (1.9% in the nonpsychiatric versus 3.8% in the psychiatric group).

The prevalence of hypothyroidism in a subgroup of 88 patients with senile and multi‐infarct dementia was 2.3%. It was not statistically different from that of the general nonpsychiatric geriatric population. The prevalence of hypothyroidism in a subgroup of 27 patients with neurotic depression was 14.8%. It was significantly higher than the prevalence found both in the overall psychogeriatric group and in the general geriatric group.

It is concluded that hypothyroidism is not involved in cognitive disorders, but may play a role in the pathogenesis of some depressive disorders in the elderly.
Acute Transmural Myocardial Infarction in Elderly Patients Hospitalized in the Coronary Care Unit Versus the General Medical Ward
Authors: Sagie Alex , Rotenberg Zvi , Weinberger Itzhak , Fuchs Jacob , Agmon Jacob
Published: April 2015

The hospital records of 126 patients over 75 years of age with transmural myocardial infarction initially treated in the coronary care unit were compared with a concurrent similar group of 94 patients admitted directly to the general medical wards. The in‐hospital mortality rate for both groups together was 40%. The mortality rate within the coronary care unit was 24% as compared with 46% in the ward group (P < 0.005). However, the mortality rate for the coronary care unit group as a whole (including those patients later transferred to the general ward) was 35 versus 46% in the ward group. Congestive heart failure and cardiogenic shock were the most frequent complications in both groups (47 and 30%, respectively), and they were the main cause of death. Patients with these complications were less likely to be successfully resuscitated, even in the coronary care unit. The overall incidence of serious ventricular arrhythmias and complete heart block was similar to that reported for younger patients. Eleven patients in the coronary care unit group were successfully resuscitated from these arrhythmias and eight survived to be discharged from hospital. In contrast, only two patients in the ward group were successfully resuscitated and eight (9%) patients died suddenly and the fatal event could not be diagnosed. We concluded that elderly patients with an acute myocardial infarction can benefit from early admission to a coronary care unit. J Am Geriatr Soc 35:915–919, 1987
Urinary Incontinence in Elderly Women: Urodynamic Evaluation
Authors: Diokno Ananias C. , Wells Thelma J. , Brink Carol A.
Published: April 2015

The objective of this study is to characterize urinary incontinence observed in elderly women and to assess the importance of various parameters used to evaluate urinary incontinence. Two hundred consecutive, ambulatory, outpatient, incontinent women 55 years of age and over who were seen at the Continence Program Clinic and completed a medical and urodynamic protocol are included in this paper. After a thorough medical history and a complete physical examination, urodynamic tests were performed. The urodynamic results showed that 77% of incontinent women had an incompetent urethra. Twenty‐five percent had a hyperactive bladder, 8% had “other” types, and 7% had a normal study. Comparison of the clinical diagnosis with the actual urodynamic diagnosis for stress incontinence revealed a 78% accuracy and only a 6% false negative. In contrast, a similar comparison for urge incontinence found only 44% accurate and 45% false negative. Analysis of the urodynamic tests revealed that the simple provocative full‐bladder stress test was as effective as the radiographic or electronic pressure measurement in detecting incompetent urethra producing stress urinary incontinence. Provocative upright cystometry was helpful in uncovering 33% of hyperactive bladders not provoked in the supine position. Complex urodynamic tests should be reserved for unexplained incontinence or when symptomatology is complex. J Am Geriatr Soc 35:940–946, 1987
Alcoholism Screening in the Elderly
Authors: Willenbring Mark L. , Christensen Kathy J. , Spring William D. , Rasmussen Reva
Published: April 2015

Alcoholism in the elderly is often underidentified because of the differences in the presentation and symptom patterns compared to younger individuals. One way to address this problem is through routine use of screening instruments, but up to this time, none of the instruments used to identify alcoholism in younger populations have been shown to be valid in the elderly. We studied the validity of the Michigan Alcoholism Screening Test, scored both with weighted (MAST) and unit scoring (UMAST), and two short versions: the Brief MAST (BMAST) and Short MAST (SMAST) in 52 hospitalized elderly male alcoholics and 33 nonalcoholic controls. The MAST and UMAST showed excellent sensitivity and specificity, while the SMAST was less specific, and the BMAST less sensitive and less specific. Factor structure of the two brief versions was similar to that found in younger alcoholics, suggesting that symptom constellation is not necessarily different in the elderly. We recommend the use of the MAST or UMAST for screening for alcoholism in the elderly. J Am Geriatr Soc 35:864–869, 1987
Morbidity and Mortality Associated with Indwelling Urinary Catheters in Elderly Patients in a Nursing Home—Confounding Due to the Presence of Associated Diseases
Authors: Kunin Calvin M. , Chin Quee Fah , Chambers Stephen
Published: April 2015

A prospective study was conducted in a nursing home among elderly residents treated with and without indwelling catheters. Most of the patients were white females with a mean age of 82.3 years. The mortality at 6 months among catheterized patients was 30.2% compared with 10.1% among the noncatheterized groups (P < 0.001). Patients with catheters differed significantly from those without in having more impaired mental status and diminished activities of daily living. They also differed significantly for eight of 30 diseases. Cerebrovascular and hypertensive disease were significantly more common in catheterized patients. In contrast, fractures and musculoskeletal disorders were significantly more common among noncatheterized patients. Catheterized patients had significantly more days with fever and symptomatic urinary tract infections and received antibiotics more often than did noncatheterized patients. We conclude that: (1) direct comparisons of morbidity and mortality among catheterized and noncatheterized populations are not valid because of confounding by the presence of associated life‐threatening illnesses; and (2) catheterized patients have more clinical episodes of urinary tract infections and fever and are treated more frequently with antibiotics.
Delirium: A Test of the Diagnostic and Statistical Manual III Criteria on Medical Inpatients
Authors: Cameron Daniel J. , Thomas Rogelio I. , Mulvihill Michael , Bronheim Harold
Published: April 2015

Although 10% to 15% of patients admitted to acute care hospitals are in a state of delirium, few patients are given this diagnosis by their clinician. We field‐tested the Diagnostic and Statistical Manual III (DSM‐III) criteria for diagnosing delirium on 133 consecutively admitted patients to an acute medical ward. Twenty patients were delirious using DSM‐III criteria, 19 more patients than were reported by the primary clinician. Seven delirious patients were less than 65 years of age (range, 32 to 64 years). Sixty‐five percent of patients with delirium died, whereas significantly fewer (3.3%) of patients without delirium died (P <.0001). We found that delirium could be readily and reliably detected (kappa coefficient of agreement = 0.62 for interrater reliability) using the DSM‐III criteria. Clinicians should routinely screen hospitalized patients of all ages using DSM‐III criteria to identify delirious patients for an immediate evaluation and treatment.
Cimetidine Use in Nursing Homes: Prolonged Therapy and Excessive Doses
Authors: Sherman David S. , Avorn Jerry , Campion Edward W.
Published: April 2015

Patterns of cimetidine use were identified in a survey of 3032 patients in 31 nursing homes. Of these, 60 (2%) were receiving cimetidine. For these patients, ages ranged from 63 to 102 years (mean, 81 years). The patients received a range of 1 to 11 regularly scheduled medications (mean, 5.6 medications). Duration of cimetidine treatment averaged 19.6 months for 48 patients (81%) receiving the drug for longer than an eight‐week course of therapy. Prescribing indications appeared unjustified in 54 of 60 patients (90%). Doses were rarely appropriately reduced for patient age, despite established reasons to do so and the well‐known potential for adverse effects of cimetidine in the elderly. The risks associated with prolonged drug‐induced suppression of gastric acid are not known. This study suggests that use of cimetidine without justifiable indication and for extended periods of time is common in nursing home patients. Studies are needed concerning the safety of long‐term cimetidine use in elderly patients.
Low Serum B12 Levels in a Hematologically Normal Elderly Subpopulation
Authors: Marcus David L. , Shadick Nancy , Crantz Joanne , Gray Michael , Hernandez Frank , Freedman Michael L.
Published: April 2015

Serum Vitamin B12 levels were determined on 378 patients ranging in age from 56 to 104 years with a median age of 77 for both males and females. A radiodilution method was employed for these determinations. This screening procedure identified 26 patients with low serum B12 levels. Nineteen of these patients had no other symptoms and were hematologically normal. The B12 binding proteins, transcobalamins (TC) I, II, and III were quantitated employing QUSO and DEAE cellulose batch separations. The total number of TC II binding/affinity sites for B12 were elevated in both the normal and low B12 elderly groups. About 17% of the total serum B12 was carried by TC II in the control group while only 4% of the total was carried on TC II in both the normal and low B12 elderly. This was accompanied by an increase in unsaturation in TC II for these two groups. The findings suggest that an alteration in the TC II‐B12 delivery system has occurred in the elderly.
A Practical Method of Estimating Stature of Bedridden Female Nursing Home Patients
Authors: Muncie Herbert L. , Sobal Jeffery , Hoopes J. Michael , Tenney James H. , Warren John W.
Published: April 2015

Accurate measurement of stature is important for the determination of several nutritional indices as well as body surface area (BSA) for the normalization of creatinine clearances. Direct standing measurement of stature of bedridden elderly nursing home patients is impossible, and stature as recorded in the chart may not be valid. An accurate stature obtained by summing five segmental measurements was compared to the stature recorded in the patient's chart and calculated estimates of stature from measurement of a long bone (humerus, tibia, knee height). Estimation of stature from measurement of knee height was highly correlated (r = 0.93) to the segmental measurement of stature while estimates from other long‐bone measurements were less highly correlated (r = 0.71 to 0.81). Recorded chart stature was poorly correlated (r = 0.37). Measurement of knee height provides a simple, quick, and accurate means of estimating stature for bedridden females in nursing homes.
Unrecognized Drug Dependence in Psychiatrically Hospitalized Elderly Patients
Authors: Whitcup Scott M. , Miller Frank
Published: April 2015

The psychiatric in‐patient records of 90 patients ≥65 years of age were reviewed retrospectively to determine the prevalence of chemical dependence and if lack of recognition and treatment of chemical dependence resulted in serious complications. Nineteen of the 90 patients were characterized as drug dependent and ten of these patients were neither recognized nor detoxified. Seven of the ten nondetoxified patients, but only one of the nine detoxified patients, experienced serious medical complications typically requiring transfer to a medical floor or medical intensive care unit. Unrecognized chemically‐dependent patients were significantly more likely to he female benzodiazepine abusers, while recognized chemically dependent patients were significantly more likely to be male alcohol abusers.
Assessment and Care of the Community‐Dwelling Alzheimer's Disease Patient
Authors: Fisk Albert A. , Pannill Fitzhugh C.
Published: April 2015

A two‐year study of 159 community dwelling Alzheimer's disease (AD) patients evaluated in a geriatric clinic is reported. Patients were not as disabled as commonly supposed, having only a moderate reduction in cognitive function (Folstein mean Mini‐Mental Status [MMS], 15.3) and physical activities of daily living (PADL), mean, 3.3, but were more dependent in their instrumental activities of daily living (IADL), mean, 1.9. Associated medical problems averaged 3.4 per patient. Forty‐seven percent lived alone and 39% had not been out of the home in the previous week, making isolation a major concern. During the study, 34% went into nursing homes. Initial mean MMS of these patients was 12.4 compared to 16.6 for patients who remained at home, but activities of daily living (ADD mean scores were not significantly different. Based on this assessment, the management of AD patients, including medication use, daycare, education and support for family caregivers, and nursing home placement, is discussed.
Establishment and Impact of a Dementia Unit Within the Nursing Home
Authors: Benson Dalton M. , Cameron Daniel , Humbach Eva , Servino Lorraine , Gambert Steven R.
Published: April 2015

Thirty‐two demented, elderly residents of a nursing home were admitted to a specially designed dementia unit. Each patient was assessed three times: prior to admission, and at four and 12 months after admission to the unit. Patients were evaluated using a modified version of a previously published assessment scale as well as with a standardized New York State numerical rating system. There was an increased level of functioning in both mental and emotional status and basic functions of daily living at both four (P ≤ 0.001) and 12 months (P ≤ 0.005). The improvement in scores was maintained over a prolonged time period, despite the expectation of progression of the dementing process. There was no change noted on the New York State assessment. Our data suggest that a select group of demented elderly can benefit from being placed on a specialized dementia unit.
Short Portable Mental Status Questionnaire as a Screening Test for Dementia and Delirium Among the Elderly
Authors: Erkinjuntti T. , Sulkava R. , Wikström J. , Autio L.
Published: April 2015

Pfeiffer's Short Portable Mental Status Questionnaire (SPMSQ) is a brief screening test for organic brain syndromes. The validity of the SPMSQ was evaluated in a random sample of 119 community residents and 282 consecutively admitted medical inpatients. The SPMSQ proved to be a sensitive and specific screening test for moderate to severe dementia both in the community and hospital. Using the cut‐off point (number of errors accepted) of three errors, the sensitivity of the test was 86.2% and the specificity 99.0% among medical inpatients. The percentages in the community sample were 66.7% and 100%, respectively. The validity of the SPMSQ was not as good for delirium because of its variable clinical picture. For screening purposes lower cut‐off points than previously recommended should be used: three errors for dementia and two errors for delirium. Among Finnish elderly people it was not necessary to use correction for education in the SPMSQ.
Influenza Vaccination in Community Elderly
Authors: Buchner David M. , Larson Eric B. , White Richard F.
Published: April 2015

Available strategies to increase influenza vaccination rates in the elderly have not been tested in the private sector where most elderly receive care. We performed a randomized controlled trial of a postcard reminder in three private general internal medicine practices. The observed vaccination rates of 55% in experimental patients (N = 262) and 54% in control patients (N = 278) were similar, though much higher than estimated national rates of 20%. The data indicated that the baseline (control group) vaccination rate was high probably because study participants were exposed to many community vaccination cues, separate from the study cue. That vaccination rates were not higher after additional exposure to the study cue suggests that a “ceiling effect” occurred. Including 70 patients not randomized into the trial because they received flu shots prior to randomization, the vaccination rate in patients who had a clinic visit during autumn months was 75% compared to a rate of 52% in patients not visiting the clinic (P <.0001).

Our results suggest that vaccination rates can be considerably higher in the private sector than those reported in the past, and that both vaccination cues and direct patient contact appear important to promote vaccination. This and other studies suggest that traditional cues may have a ceiling effect, yielding vaccination rates no higher than 55 to 65%; further increases in rates will require other approaches.
Direct Assessment of Activities of Daily Living in Alzheimer's Disease A Controlled Study
Authors: Skurla Ellen , Rogers Joan C. , Sunderland Trey
Published: April 2015

The relationship between severity of dementia and performance in four experimental tasks was studied in nine patients with Alzheimer's disease and nine age‐matched controls. The experimental tasks were developed in order to establish a direct measure of functional performance in common activities of daily living. In the Alzheimer's patients, significant but moderate positive associations were found between the Clinical Dementia Rating Scale (CDR), a comprehensive rating tool designed specifically for Alzheimer's disease, and performance on the experimental tasks. A significant correlation was also found between the results of the Short Portable Mental Status Questionnaire (SPMSQ), a less specific dementia assessment instrument, and the CDR but not between the SPMSQ and the performance measure. When compared to nine normal subjects matched for gender, age, and education, the cognitively impaired subjects required more assistance and time (P < .01) in completing the tasks. The findings support the conclusion that severity of dementia and performance on activities of daily living tasks are related but distinct concepts and should be measured separately.
Hospital Versus Random Digit Dialing Controls in the Elderly Observations from Two Case‐control Studies
Authors: Robertson Susan J. , Grufferman Seymour , Cohen Harvey J.
Published: April 2015

Finding an optimal source of controls is a major consideration in the design of case‐control studies. While hospital patients can provide a relatively economical and convenient source of controls, hospital controls may have diseases independently associated with the exposures being studied. Results of a recent case‐control study of multiple myeloma suggest that the problems of using hospital controls may be exacerbated in studies of diseases affecting the elderly, especially when considering risk factors which might be associated with chronic diseases. Apparently, the authors have encountered a modern analog of “Berkson's bias” in which cancer cases are referred to a tertiary care center for a single disease. On the other hand, noncancer patients who might serve as controls tend to be referred selectively if they have multiple diseases. This article reports some of the difficulties encountered in a case‐control study whose mean case age was 63.4 years and suggests that community controls selected by random digit dialing may be preferable to hospital controls for hypothesis‐generating case‐control studies of diseases in the elderly.
The Ethics Committee in the Nursing Home Results of a National Survey
Authors: Glasser Gary , Zweibel Nancy R. , Cassel Christine K.
Published: April 2015

As the complexity, prevalence and visibility of ethical dilemmas in medical care of the elderly have grown, hospitals and nursing homes have attempted to develop mechanisms for responding to these difficult ethical issues. While it is known that many hospitals rely on education and advice provided by an ethics committee, little data exist on the responses of nursing homes, despite the unique nature of ethical issues in a long‐term care setting.

The present paper reports findings from a national survey of administrators of 4504 nursing homes in which mechanisms for handling ethical dimensions in patient care were investigated. Results from 29% of respondents reveal that few nursing homes have established ethics committees (2% of the sample) and that committee formation appears positively associated with facility size and religious affiliation. Committees that have been formed engage in policy review (81%), advisory case review (67%) and education (45%). Few committees include patients or their representatives as members, and few have the authority to make binding decisions (26%).

While the most effective response to ethical issues in medical decision‐making is being debated, standing committees provide one means to contribute to the quality of decision‐making by patients, their family members and their physicians. However, broader inclusion of patient perspectives and education of members regarding ethical analysis are necessary precursors to effective functioning of ethics committees in long‐term care.
Metabolic Changes in Alzheimer's Disease
Authors: Fisman Michael , Gordon Bruce , Feleki Vera , Helmes Edward , McDonald Thomas , Dupre John
Published: April 2015

Patients with Alzheimer's disease (AD) and matched controls fasted for 24 hours, and serial glucose, pyruvate, lactate, β‐hydroxybutyrate, acetoacetate, insulin, and glucagon levels were measured. Patients with AD showed a glucose insulin correlation pattern over the 24 hours that differed from the control group. These differences may be secondary to weight loss or to other metabolic or nutritional factors affecting the AD patients.
Alcohol Use in a Community‐based Sample of Subjects Aged 70 Years and Older
Authors: Busby W. J. , Campbell A. J. , Borrie M. J. , Spears G. F. S.
Published: April 2015

The usual alcohol intake in a community‐based sample of subjects aged 70 years and over was investigated. A sample of 825 subjects was drawn from the records of five general practices in a rural township and 774 subjects (93.8%) agreed to participate. A stratified sub‐sample of subjects from the abstainers, infrequent, weekly, and daily drinkers was subsequently investigated in more detail. Men took alcohol more frequently than women and in greater quantities although frequency and amount decreased with age. The usual place for drinking was the home. The highest use of psychotropic drugs occurred in the abstainers, but this was significant for men only. When compared with drinking patterns in middle age, 60.1% of men and 30.3% of women said that they took less alcohol, while 7.4% of men and 11.1% of women said that they took more. The main reasons for decrease in alcohol intake were change in health and fewer social opportunities. The main reasons for increase in alcohol intake were more money and more time. Drinking was most commonly associated with social activities and few took alcohol to help cope with personal situations.
A Telephone Support Service to Reduce Medical Care Use Among the Elderly
Authors: Infante‐Rivard Claire , Krieger Monique , Petitclerc Marcelle , Baumgarten Mona
Published: April 2015

A randomized controlled trial was performed to determine whether a telephone support system could reduce the frequency of ambulatory physician encounters. A total of 182 elderly persons were enrolled in the study. The experimental group was regularly called by a public health nurse and could call the nurse every weekday during normal working hours. The control group received no intervention. A year later, the experimental group reported 7.40 ambulatory encounters with a physician (SD = 4.94) and the control group reported 8.61 encounters (SD = 6.85). The difference between the groups, after adjusting for various prognostic factors, was 1.20 (95% confidence interval, −0.84 to 3.24). Although the difference did not achieve statistical significance, the results suggest that telephone support may bring about a substantial decrease in medical care utilization. Further research assessing the cost‐advantage ratio for this type of intervention is recommended.
Diabetes Mellitus in Elderly Nursing Home Patients A Survey of Clinical Characteristics and Management
Authors: Mooradian Arshag D. , Osterweil Dan , Petrasek Daniel , Morley John E.
Published: April 2015

The clinical features of 47 frail nursing home diabetic patients with a mean age of 81 ± 1.6 years were compared to those of 61 nondiabetic nursing home residents with a mean age of 80.2 ± 1.2 years. Diabetic patients had a higher prevalence of renal failure, proteinuria, retinopathy, neuropathy, and infections than did other nursing home residents. Macroangiopathic disease tended to be equally common in both age groups. Diabetic nursing home residents had higher body weights compared to nondiabetic nursing home residents. Surprisingly, however, 21% of nursing home diabetics were greater than 20% below average body weight (compared to 24.5% of other nursing home residents), suggesting that undernutrition is a major problem in diabetic patients in a nursing home setting. Overall, the diabetic nursing home patients had better blood glucose control than younger ambulatory diabetic patients (mean age 66.2 ± 4.7 years). The glycosylated heomglobin (HbA1) level in those on oral agents was 8.9% ± 0.7% for nursing home patients compared to 11.8% ± 0.7% in ambulatory patients (P < 0.01). The HbA1 in insulin‐treated patients was similarly lower in nursing home diabetics (9.6% ± 0.4% vs 11.8% ± 0.7, P < 0.05). There were only two mild hypoglycemic episodes in nursing home patients over 6‐month observation period, whereas 12 ambulatory patients reported hypoglycemic episodes during the same period of time. We conclude that although the diabetic nursing home patients are sicker than the ambulatory diabetics, it is possible to achieve a fair blood glucose control in nursing home patients without a significant risk of recurrent hypoglycemia.
Conflicting Attitudes Toward Euthanasia for Severely Demented Patients of Health Care Professionals in Sweden
Authors: Waxman Howard M. , Astrom Sture , Norberg Astrid , Winblad Bengt
Published: April 2015

This survey study of 1,798 Swedish health care workers in 31 acute and chronic institutional settings found considerable disagreement between staff concerning euthanasia. For example, attitudes of aides and LPNs, were significantly (χ2 = 42.0, P < .0001) more favorable toward active euthanasia (38.9% of aides and 28.8% of LPNs were neutral or approved) than were RNs and physicians (20% and 14.9%). This disagreement was most apparent among those staff in institutions with many demented patients. Favorable attitudes were also more frequent among aides experiencing job dissatisfaction and “burnout,” younger staff, and those without a relative in long‐term care. Possible reasons for favorable attitudes toward active euthanasia and staff attitude polarization are discussed along with implications for patient care.
The CAMDEX: A Standardized Instrument for the Diagnosis of Mental Disorder in the Elderly: A Replication with a US Sample
Authors: Hendrie Hugh C. , Hall Kathleen S. , Brittain Harry M. , Austrom Mary G. , Farlow Martin , Parker Jane , Kane Michael
Published: April 2015

The Cambridge Mental Disorders of the Elderly Examination (CAMDEX) was developed by Roth, et al (1986) to assist in the early diagnosis and measurement of dementia in the elderly. In this study the CAMDEX was administered to a mixed group of independently diagnosed elderly psychiatric patients and control subjects in the United States. The CAMDEX was found to have a high interrater reliability with a mixed group of clinicians of varying backgrounds. The diagnostic scales and the cognitive section of the CAMDEX demonstrated considerable promise in distinguishing between independently diagnosed populations of depressed, demented, and normal subjects. The results suggest comparability between samples of subjects in England and the US, and that the CAMDEX is a promising instrument for use in both research and clinical settings.