bluuebunny/crossref_metadata_2025 huggingface dataset:
Usefulness of Routine Preoperative Chest Roentgenograms in Elderly Patients
Authors: Boghosian Shaken Gh. , Mooradian Arshag D.
Published: April 2015

One hundred thirty‐six charts of preoperative patients over the age of 59 years were reviewed to determine whether clinical criteria alone are sufficient to identify patients who would not benefit from preoperative chest roentgenograms. Thirty‐four percent of the patients without risk factors and 62% of those in the high‐risk group were found to have significant abnormalities on chest roentgenograms (P < 0.05). Postoperative complications occurred in 20% of patients in the high‐risk group compared to 11% complication‐rate in patients without clinical risk factors. The difference is not statistically significant. The prevalence of abnormal preoperative chest roentgenograms among those over the age of 70 years (49%) was not significantly different from the prevalence in those between the ages of 60 and 70 years (59%); however, the incidence of major postoperative complications was significantly higher in the older group (17 v 4%, P < 0.01). Because of the substantial prevalence of abnormal chest roentgenograms and postoperative complications, it is concluded that in the elderly preoperative patients, in particular those over the age of 70 years, chest roentgenograms should be done on all patients regardless of clinical history.
Two‐Stage Tuberculin Testing With Control Antigens in Patients Residing in Two Chronic Disease Hospitals
Authors: Barry M. Anita , Regan Anne Marie , Kunches Laureen M. , Harris Marjorie E. , Bunce Sally A. , Craven Donald E.
Published: April 2015

We studied the prevalence of tuberculin reactivity and anergy in 360 elderly patients residing in two municipal chronic disease hospitals. Eighty‐five (26%) of the 323 patients tested had a positive reaction to a stage 1 tuberculin test and 12 (6%) of the 207 stage 1 tuberculin‐negative patients exhibited a booster response to a stage 2 tuberculin test. Thirty percent of the same 207 patients had no response to an anergy panel of skin test antigens that included Candida, mumps, and trichophyton.

Nonresponders to tuberculin and the anergy panel had significantly higher one‐year mortality rates compared to responders (44 v 20%, P= 0.001). Tuberculin‐positivity among the 770 employees working in these facilities was 43%; 12 (4%) had a booster response. A survey of 29 randomly selected long‐term care facilities in the Boston area indicated that all had a policy for pre‐employment screening of employees, but less than 50% had a policy for patients and only one institution used two‐stage testing. Routine tuberculin testing is recommended for long‐term care facilities and the two‐stage method is preferable in institutions with adequate resources.
Longitudinal Change in Three Brief Assessments of SDAT
Authors: Berg Gary , Edwards Dorothy Farrar , Danzinger Warren L. , Berg Leonard
Published: April 2015

Previous research has shown that there is considerable interest in the development of brief indices for use in the diagnosis and staging of senile dementia of the Alzheimer's type (SDAT). Examples of such measures include the Blessed Dementia Scale (BDS) and Pfeiffer's Short Portable Mental Status Questionnaire (SPMSQ). A third measure used in the assessment of organic cognitive impairment is the Face‐Hand Test (FHT). This study, which was part of a large longitudinal investigation of SDAT, examined the performance of 43 subjects with SDAT and 57 healthy controls over 30 months. The subjects were assessed three times during this period. In addition to the brief measures (BDS, SPMSQ, and FHT) all subjects were rated on a Clinical Dementia Rating (CDR) Scale based on a lengthy clinical interview. The data were analyzed by means of a series of univariate, repeated measures ANOVAs, and discriminant analysis. Results indicate: 1) control scores did not change over time on any of the measures; 2) when classified according to severity of SDAT, different patterns of performance emerged over time for each measure; and 3) it is difficult to accurately predict progression of SDAT from the three scores.
Extracorporeal Shock Wave Lithotripsy for the Treatment of Urinary Calculi in the Elderly
Authors: Kramolowsky Eugene V. , Quinlan Stephen M. , Loening Stefan A.
Published: April 2015

Renal calculus in the elderly patient is associated with the same symptoms and risks as in other patient populations. With the recent development of extracorporeal shock wave lithotripsy (ESWL), many older patients can now be treated for renal calculi. The Department of Urology at the University of Iowa Hospitals and Clinics has performed 107 ESWL treatments on a total of 96 patients over 70 years of age. This represents 1over 12% of all patients treated at our institution. No deaths related to ESWL treatment have occurred in this group, nor has increased morbidity been observed in comparison to all patients treated. In spite of the increased age and associated medical problems of this patient population, ESWL offers a safe and effective means of treating upper tract urinary calculi in the geriatric age group.
The Aging Thyroid: II. An Immunocytochemical Analysis of the Age‐Associated Lesions
Authors: Blumenthal Herman T. , Perlstein Irving B.
Published: April 2015

This study utilizing immunocytochemical techniques consists of two segments, 1) an analysis of the changes with age in the hormone content of normal, involuting, macro‐and microfollicles, as well as calcitonin (C) cells, and 2) an analysis of the components of the lesion characteristic of lymphocytic thyroiditis.

Involuting and macro‐ (cystic) follicles show a decline in hormone content with age, while microfollicles show a variable pattern with some showing a high and others a low content, as well as some showing an absence of hormone. There also appears to be an increase with age in hormone‐containing C cell micronodules, but we were unable to demonstrate a decline in hormone content of individual C cells.

Studies on the in vivo binding of immunoglobulins, as an indicator of thyroid antibody binding, showed an increase with age in IgG and IgM binding to follicular epithelium. Much stronger reactions were observed in the epithelium of microfollicles than in that of involuting or macrofollicles. There were also examples of presumptive in vivo antibody binding by C cell micronodules.

We were unable to demonstrate an imbalance of helper/suppressor T cell ratio in the thyroiditis lesion, but did find that some lymphocytes contain thyroid hormones, suggesting that the latter may act as cytokines and assist in the perpetuation of the lesion. The epithelial expression of human lymphocyte antigens (HLA) was strong in microfollicles and weak or absent in involuting or macrofollicles in sections with lymphocytic thyroiditis. It was also strong in the epithelium of a microfollicular adenoma without a lymphocytic infiltrate while weak or absent in the epithelium of adjacent normal follicles.

These observations have led to the proposal that the lesion of lymphocytic thyroiditis may be initiated by an age‐associated proliferation of “not self” dysplastic microfollicles which express the HLA surface antigen, and that the early lymphocytic infiltrate is targeted against these microfollicles in the form of an antibody mediated cytotoxic reaction. J Am Geriatr Soc 35:855–863, 1987
The Impact of Age on Utilization of Intensive Care Resources
Authors: McClish Donna Katzman , Powell Stephen H. , Montenegro Hugo , Nochomovitz Michael
Published: April 2015

The impact of age on admission practices and pattern of care were examined in 599 admissions to a medical intensive care unit (MICU) and 290 patients on the conventional medical care divisions of the same hospital. Four age groups were compared: under 55, 55 to 64, 65 to 74, and 75 years of age and over. Severity of illness and prior health were assessed using the Acute Physiology Score (APS) and the Chronic Health Evaluation (CHE) instruments. Resource utilization was assessed using the Therapeutic Intervention Scoring System (TISS) and hospital charges.

Patients 65 years of age and over comprised 48% of the MICU sample. The distribution of CHE was different among the four groups. Twenty‐one percent of patients under 55 years of age had no prior chronic illness, as compared to less than 8% of older patients. The APS at admission was similar for all age groups, as was admission, daily, and total TISS. Hospital survival declined with age from 85% to 70%, while the likelihood of being designated do not resuscitate (DNR) increased from 10% to 24%. Differences in hospital survival disappeared when controlling for severity of illness and prior health, but differences in DNR status did not. Still, elderly DNR patients received as much resources as younger DNR patients and this was more than non‐DNR patients.

The sample of patients treated on conventional medical divisions had age distribution similar to the MICU sample. There was some evidence that admission APS (median, 5, 5, 6, 6, respectively, P = .055) and maximum APS (median, 5, 5, 7, 8, respectively, P = .023) differed slightly across age groups. Yet elderly patients admitted to the MICU from the divisions were no sicker than younger patients (median, 19.0, 17.0, 17.5, 18.0, P = .9713). We conclude that there were no selective barriers restricting access of the elderly to the MICU and that once admitted to the MICU, treatment patterns differed only in the application of DNR status. J Am Geriatr Soc 35:983–988, 1987
Predicting Performance on the Mini‐Mental State Examination
Authors: Magaziner Jay , Bassett Susan Spear , Rebel J. Richard
Published: April 2015

Inclusion of a mental status examination in research and clinical screening instruments lengthens the protocol, thereby adding to the difficulty of using instruments addressing all relevant issues under study without taxing participants. The purpose of the present study was to evaluate the possibility of substituting a subset of items from the widely used Mini‐Mental State Examination (MMSE) for the entire examination in order to reduce the time needed to screen for cognitive status. Study data came from a health study of 783 community‐dwelling, white females, 65 years of age and over, selected randomly from a 20‐census‐tract area of northeast Baltimore. Results indicate that seven MMSE items can be used to reliably predict total MMSE scores. Because of an age × education interaction in the prediction of total MMSE scores, four age × education‐specific predictive equations were developed. These four equations are most useful for predicting continuous MMSE scores rather than for categorizing individuals according to imparied versus unimparied status. A short form of the MMSE and four age × education‐specific scoring equations are presented and their potential utility discussed.
UCLA Geriatric Grand Rounds Sexual Dysfunction in the Elderly Male
Authors: Morley John E. , Korenman Stanley G. , Mooradian Arshag D. , Kaiser Fran E.
Published: April 2015

“O Venus, cruel mother of amorous desires, cease attempting to bring under your yoke a man now arrived at his fiftieth year, and therefore stubborn to submit to your voluptuous commands.”

To Venus

Horace (68 BC)
The Prevalence and Design of Ethics Committees in Nursing Homes
Authors: Brown Barbara A. , Miles Steven H. , Aroskar Mila A.
Published: April 2015

A dramatic increase in the number of ethics committees in long‐term care facilities (LTCFs) has occurred since 1970 in the 487 nursing homes in Minnesota. Ten percent of the LTCFs had ethics committees which were mostly formed by administrators and nurses. The committees are most often found in large urban facilities with a high percentage of skilled‐level beds and a religious name. The committees are multidisciplinary with a median of nine members including two to three nurses, a physician, a social worker, a minister, an administrator, and three other members. Nearly all committees were involved in policy development and staff education. Additional functions included resident care consultation and retrospective case review. More than half of the committees are accountable to administration. Nearly all committees kept minutes. Though all committees incurred costs, only one had a formal budget. Informal evaluation is done in only six committees. No committee had referred cases to the courts.
The Care of Elderly Patients by Elderly Physicians
Authors: Reuben David B. , Robertson Jean Burritt
Published: April 2015

To examine the content of care that elderly patients receive from physicians 5.65 years of age, data from the 1981 National Ambulatory Medical Care Survey were analyzed. Compared to physicians aged 35 to 54 years, elderly physicians devoted a larger proportion of their practices to the care of elderly patients. In caring for these patients, elderly physicians spent more time per visit than did younger physicians and were more likely to conduct general examinations and provide counseling. In contrast, elderly physicians were less likely to perform mental status or vision examinations. Elderly physicians were also less likely to provide telephone follow‐up for those patients ≥ 75 years of age and more likely to discharge patients ≥ 65 years of age without any specific follow‐up planned. These data suggest that the content of care for elderly patients may differ substantially depending upon the physician's age.
Biomedical Research in the Nursing Home: Methodological Issues and Subject Recruitment Results
Authors: Lipsitz Lewis A. , Pluchino Frances C. , Wright Susan M.
Published: April 2015

Although nursing homes are potentially important sites for geriatric research, previous reports have identified impediments to subject recruitment in this setting. We are conducting five simultaneous clinical studies in a 725‐bed nursing home. Utilizing a systematic subject recruitment methodology designed to minimize patient and staff burden, we have recruited over 100 subjects. The average recruitment rate over two years from nursing home residents meeting study entry criteria was 43%. The rate was highest (81%) for a study of urinary incontinence offering direct benefit to participants, and lowest (28% and 14% respectively) for physiologic studies of vasopressin regulation and dermal vitamin D production, offering no direct benefit. Studies of syncope and dementia which benefitted groups affected by these problems but not controls, had intermediate recruitment rates (46 and 44%, respectively, P < .002 compared to incontinence). Thus, clinically relevant projects, sensitive to the needs of the patient and institution, can recruit subjects from the nursing home.
Villonodular Synovitis of the Shoulder in the Elderly
Authors: Ganel A. , Pritsch M. , Yaffe B. , Engelberg S. , Apter S.
Published: April 2015

Villonodular synovitis of the shoulder developed in two elderly patients. Huge soft tissue mass, marked joint effusion, and radiographs demonstrating severe osteoarthritic changes characterized these patients. Localized shoulder muscle atrophy accounts for residual painfree limitation of active shoulder motion following synovectomy of the shoulder joint.
Daily Multivitamin Supplementation and Vitamin Blood Levels in the Elderly: A Randomized, Double‐Blind, Placebo‐Controlled Trial
Authors: Mann Bruce A. , Garry Philip J. , Hunt William C. , Owen George M. , Goodwin James S.
Published: April 2015

Despite the many questions being raised about multivitamin use by the elderly, it has not been proven that consuming an oral multivitamin alters vitamin blood levels in the aged. To address this question, we performed a randomized, prospective, placebo‐controlled study of daily multivitamin supplementation in 101 noninstitutionalized ambulatory elderly persons (median age, 64 years). Vitamin levels were assayed at baseline, and at two and four months of supplementation. At four months, those taking multivitamins had statistically significant increased levels of water soluble vitamins (C, B2, B12, plasma, and erythrocyte folate) that were greater than changes noted for the placebo group. This was not true for fat soluble vitamins A and E. Greater storage pools of fat soluble vitamins help explain this discrepancy. We conclude that in the ambulatory elderly, oral multivitamins can raise levels of water soluble vitamins but the effect on fat soluble vitamins remains uncertain.
Intensive Care for the Elderly: Outcome of Elective and Nonelective Admissions
Authors: Sage William M. , Hurst Carolyn R. , Silverman James F. , Bortz Walter M.
Published: April 2015

Survival, quality of life, and need for continuing medical care were evaluated for 134 elderly patients admitted to the intensive care units (ICU) at Stanford University Hospital and for a control group. Of the patient group, 57.5% were admitted to the ICU following elective surgery; 42.5% were emergency surgical and medical patients. Hospital mortality was 3.9% for elective and 22.8% for nonelective patients; 18‐month mortality was 13.0% and 47.4%, respectively. Fifty‐nine patients (60.8% of survivors) completed follow‐up questionnaires. Subjective and objective quality of life was good. Quality of life was slightly worse for ICU survivors than for controls; elective and nonelective patients did not differ significantly. Although the cost of ICU hospitalization was high, additional medical care was not excessive. Nonelective patients required more continuing care than elective patients, and both groups required more than controls.
Incontinence Among Nursing Home Patients: Clinical and Functional Correlates
Authors: Ouslander Joseph G. , Uman Given C. , Urman Harold N. , Rubenstein Laurence Z.
Published: April 2015

This study was undertaken to examine the association of specific medical and genitourinary conditions, medications, and functional disabilities with urinary incontinence (UI) in a nursing home (NH) population. Seventy‐six incontinent and 38 continent patients in a Veterans Administration NH were studied. Incontinence was highly associated with each of the physical and mental functional disabilities we examined. However, with the exception of recurrent urinary tract infections and dementia, no specific clinical factors were significantly more common among incontinent than continent patients. Although precise causes for the UI were not determined, these data highlight the potential role of impairments of physical and/or mental function in the pathogenesis of UI among NH patients, and emphasize the need to address these impairments in future research on the assessment and treatment of UI in this population.
Geriatric Patient Outcomes and Costs in Three Settings: Nursing Home, Foster Family, and Own Home
Authors: Braun Kathryn L. , Rose Charles L.
Published: April 2015

Forty‐nine matched triads of geriatric patients were compared after three months in their respective placement settings: nursing homes, geriatric foster homes, and own homes with supportive services. Compared to similarly disabled patients in nursing homes, patients in the two community settings made greater improvements in selfcare skills and mobility, expressed greater well‐being, had similar types and amounts of morbidity, and entailed lower costs. The results support the expansion of home and community‐based services as alternatives to institutional care for a substantial number of geriatric patients.
A Double‐Blind Placebo Controlled Evaluation of the Safety and Efficacy of Vinpocetine in the Treatment of Patients with Chronic Vascular Senile Cerebral Dysfunction
Authors: Balestreri Roberto , Fontana Luigi , Astengo Federico
Published: April 2015

In a double‐blind clinical trial, vinpocetine, a synthetic ethyl ester of apovincamine, was shown to effect significant improvement in elderly patients with chronic cerebral dysfunction. Forty‐two patients received 10 mg vinpocetine three times a day (tid) for 30 days, then 5 mg lid for 60 days. Matching placebo tablets were given to another 42 patients for the 90 day trial period. Patients on vinpocetine scored consistently better in all evaluations of the effectiveness of treatment including measurements on the Clinical Global Impression (CGI) scale, the Sandoz Clinical Assessment‐Geriatric (SCAG) scale, and the Mini‐Mental Status Questionnaire (MMSQ). There were no serious side effects related to the treatment drug.
Cardiopulmonary Resuscitation in Long‐term Care Facilities: A Survey of Do‐not‐resuscitate Orders in Nursing Homes
Authors: Levinson Wendy , Shepard Mary A. , Dunn Patrick M. , Parker Dorothy F.
Published: April 2015

Growing public debate regarding no cardiopulmonary resuscitation (no‐CPR) policies in acute care hospitals, together with recent changes in the patient population of long‐term care facilities, has led nursing homes to examine their need for resuscitation policies. To determine current cardiopulmonary resuscitation policies and procedures in nursing homes, medical directors and directors of nursing service in long‐term care facilities in Portland, Oregon, were surveyed. Seventy‐five percent responded; of these, only 41% reported having a resuscitation policy. Of those with no policy, 70% thought one was needed. Most nursing homes reported that resuscitation was infrequently discussed with patients and families. When a no‐CPR determination was made, it was usually documented in the patient's chart. Training in basic life support was required for registered nurses in two thirds of the facilities. Few homes had equipment necessary for advanced life support. It is recommended that: a) nursing homes develop cardiopulmonary resuscitation policies; b) resuscitation orders be made part of the medical record; and c) nursing home personnel increase their ability to perform basic life support.
External Catheter Use and Urinary Tract Infections Among Incontinent Male Nursing Home Patients
Authors: Ouslander Joseph G. , Greengold Barbara , Chen Sophia
Published: April 2015

In order to examine the relative frequency of urinary tract infection (UTI) and bacteriuria among male nursing home patients managed with and without external catheters (EC), we prospectively followed four cohorts of patients (EC worn continuously, N = 30; EC worn at night only, N = 19; incontinent without catheter, N = 13; and continent, N = 30) for a total of 497 patient months at risk. The proportion of patients with EC worn continuously who had at least one episode of bacteriuria (87%) and at least one UTI (40%), and the incidence of UTI (0.08 episodes per patient‐month at risk) was significantly higher than among continent or incontinent patients without EC. Patients with EC at night only had an intermediate frequency of these findings. Differences in clinical and functional status characteristics among the four cohorts, in addition to the use of EC, could have contributed to the higher frequencies of bacteriuria and UTI. None of the clinical characteristics we examined were associated with the development of UTI among patients with EC. Further studies are necessary to identify factors associated with UTI among patients who are managed by EC so that effective preventive strategies can be developed and targeted to patients at high risk.
The Quality of Medical Care Received by Older Persons
Authors: Siu Albert L.
Published: April 2015

This paper reviews studies published since 1970 on the quality of medical services received by older persons. Although many of the studies were flawed in design or limited in scope, they suggest that there are problems in the quality of care received by older persons in ambulatory, hospital, and nursing home settings. Changes in health care delivery and financing should attempt to improve, rather than merely maintain, the quality of medical and health services received by this vulnerable population.
The Clinical Case Against Tube Feeding in Palliative Care of the Elderly
Authors: Campbell‐Taylor I. , Fisher R. H.
Published: April 2015

The terminal stages of many neurological illnesses occurring in the elderly produce feeding and swallowing problems. These difficulties lead to ethical, religious, philosophical, and medico‐legal conflicts when decisions about starting or stopping tube feedings are considered. We present the case against all forms of tube feeding in a particular subset of elderly palliative patients. These are individuals who are in the end‐stage of a progressive neurological disease who are noncommunicative, and spend all or most of their time in a recumbent position. We discuss the physiological phenomena existing in these patients that make the probability of aspiration pneumonia as great or possibly greater than with careful spoon feeding. If tube feeding results in the outcome that it is thought to prevent (ie, aspiration pneumonia) then decisions regarding nutritional support in these patients become clinically clearer.
Trial of a Geriatric Consultation Team in an Acute Care Hospital
Authors: Gayton David , Wood‐Dauphinee Sharon , de Lorimer Marie , Tousignant Pierre , Hanley James
Published: April 2015

A controlled trial was conducted to examine the effects of superimposing an interdisciplinary geriatric consultation team upon the conventional patterns of care in medical wards of an acute care hospital. Two hundred and twenty‐two patients, aged 69 years of age or older, admitted from the emergency room to two trial wards and 182 similar patients admitted to two control wards where the team did not work, were followed. Evaluations at admission, two and four weeks, and three and six months postadmission by independent evaluators allowed comparisons between the care groups with reference to survival, length of stay, disposition, physical, mental, and social functional levels, and use of services after discharge. Data from charts and treatment logs allowed the care processes to be compared. Findings determined that patients in the two groups were alike on socio‐demographic and clinical characteristics at entry. Results demonstrated that patients in the trial and control groups fared similarly on the outcome measures at each evaluation point, although a trend toward better survival among team patients was noted. It was concluded that the addition of a consultative geriatric team to the medical wards failed to show a significant impact on patient outcomes.
Report of the Institute of Medicine
Authors:   Committee on Leadership for Academic Geriatric Medicine
Published: April 2015

The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen from their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.
Late Onset Schizophrenia‐like Illness
Authors: Craig Thomas J. , Bregman Zachary
Published: April 2015

A chart review of 658 psychiatric inpatients aged 65 years or older with a clinical diagnosis of schizophrenia revealed 32 patients (4.8%) with onset of symptoms after aged 45 who met DSM‐III criteria for schizophrenia (except age of onset). Clinical course and response to treatment revealed only 25% to follow an unequivocally schizophrenic pattern. Almost 20% demonstrated substantial affective symptomatology, whereas 15.6% had a brief psychotic episode with full remission, and 40.6% showed signs of organic deterioration. These results suggest that diverse underlying pathologic processes may present initially as late onset schizophreniform illness. The presence of depressive symptoms and assaultive behavior on admission predicted good treatment response while sensory deficits and development of signs of organicity were associated with poor treatment response.
Quantifying the Ease or Difficulty Older Persons Experience in Opening Medication Containers
Authors: Keram Stevan , Williams Mark E.
Published: April 2015

To compare the difficulty experienced by older persons in using various medication containers, 50 noninstitutionalized women and men over 60 years of age were timed while opening 15 containers. Pill and liquid medication bottles with and without child‐resistant closure mechanisms were tested. In addition, other types of medication packaging were evaluated, such as nitroglycerin patches.

All subjects could open each of the non‐child‐resistant containers, though none of the child‐resistant containers could be opened by all participants. For child‐resistant containers, dramatic differences were observed in the proportion of subjects who could open the various designs and in the amount of time required. Subjects' comments and observations of subjects' efforts provided possible reasons for some of these differences.

The results suggest that when child‐resistant containers are used, consideration of the type of medication container can significantly reduce inconvenience to older persons. Containers without child‐resistant mechanisms provide the best option for elderly people when access by small children is not an issue.
Hospital Length of Stay of Frail Elderly Patients: Primary Care by General Internists versus Geriatricians
Authors: Pawlson L. Gregory
Published: April 2015

Hospitalized patients in a medical diagnosis‐related group (DRG) who were cared for by physicians in a division of Geriatric Medicine (geriatric group) were compared with a control group drawn from a stratified random sample of patients cared for by general internists (internist group) in the same hospital. Despite an older age, longer predicted length of stay, and higher DRG reimbursement, the geriatric group patients had a significantly shorter length of stay (8.8 vs 15.8 days; P < 0.05) than the internist group. A shorter length of stay for the geriatric group was noted in each of five subgroups, sorted by admission and discharge status. Comparison to national data reveals that, despite the shorter length of stay in the geriatric group, length of stay data used by hospitals for management purposes would still classify the patients of the geriatrics group as “revenue losers” under the Medicare hospital reimbursement system.
Immunization of Elderly People with High Doses of Influenza Vaccine
Authors: Gross P. A. , Quinnan G. V. , Weksler M. E. , Gaerlan P. F. , Denning C. R.
Published: April 2015

Healthy ambulatory elderly were immunized with increasing doses of the 1984–1985 influenza vaccine formulation. Two types of vaccines, split‐product vaccine (SPV) and whole virus vaccine (WVV), were used. Three different doses, 0.5 mL (the standard volume, 1X), or 1.0 mL (2X), and 1.5 mL (3X) of each of the two vaccines were compared. The size of each of the six groups was between 23 and 26 subjects. The mean ages in each of the groups ranged from 71 to 74 years. No difference in local or systemic reaction was noted among the six groups. A dose‐response effect was observed for the SPV recipients to the influenza A/Chile/83 (H1N1) strain. The geometric mean hemagglutination inhibition (HI)titer (GMT) was 1:76 after the 3X dose vs 1:38 after the 1X dose (P < 0.025). To the influenza A/Philippines/82 (H3N2) strain the GMT was 1:70 after the 3X dose vs 1:43 after the 1X dose. A similar trend was noted for the influenza B/USSR/83 strain. A (HI) titer of ≥ 1:40 for all the strains was seen in > 70% of the split product vaccine recipients only after the 3X dose. For the WW recipients, increasing doses did not result in increasing GMT for any of the three vaccine strains. In addition, HI titers ≤ 1:40 were not uniformly seen in > 70% of the vaccine recipients at any of the three whole virus vaccine doses. In conclusion, a dose three times the standard dose of commercially available inactivated influenza vaccine is not uniformly superior to the standard dose of vaccine. The humoral immune response to influenza vaccine appears to be comparable in healthy elderly adults and in younger adults when most have been previously immunized.
Thyroid Hormone Indices in Adult Healthy Subjects: No Influence of Aging
Authors: Kabadi Udaya M. , Rosman Paul M.
Published: April 2015

Controversy exists regarding the influence of aging on thyroid hormone metabolism. Several investigators report lowering of T3 and/or a rise in reverse T3 (rT3) in elderly subjects. Others suggest that these thyroid hormone alterations were secondary to associated disorders rather than old age, and questioned the “healthy” status of the subjects studied in the earlier reports. Therefore, to assess the possible effect of aging we studied T3 resin uptake, T4, free T4, T3, and rT3 concentrations in 152 euthyroid healthy adult subjects. These subjects were selected carefully and were therefore devoid of any illness, acute or chronic, and were not treated with any medications at the time of study. No significant alterations were noted in any of the thyroid hormone concentrations in subjects divided into groups according to age. Nor was there a significant difference in these parameters between men and women of any individual age group or for all ages combined. Therefore, old age per se may not influence thyroid hormone metabolism and hence may not induce changes in serum thyroid hormone concentrations. The changes in thyroid hormones noted previously in elderly subjects may be a reflection of concurrent disorders and not old age.
Insulin Sensitivity and Beta‐Cell Responsivity Are Not Decreased in Elderly Subjects With Normal OGTT
Authors: Pacini G. , Beccaro F. , Nosadini R. , Cohelli C. , Crepaldi G.
Published: April 2015

Glucose intolerance has been observed often in elderly subjects, but it is not yet clear whether this impaired metabolic state is due to the aging process itself or is secondary to the appearance of other age‐related variables. This study attempts to elucidate the effect of age in itself on factors controlling glucose tolerance. Several metabolic parameters were measured in 10 young male controls (23–29 yr) and 17 nonhospitalized, healthy, nonobese, old (60–80 yr) male subjects. Insulin binding to circulating cells was performed along with the intravenous glucose tolerance test, and the data were analyzed by the minimal model method. This approach yields the following measures: tissue insulin sensitivity (SI), fractional glucose disappearance at basal insulin (glucose effectiveness, SG), and first (φ1) and second (φ2) phase β‐cell responsiveness to glucose. Insulin‐binding capacity to monocytes and erythrocytes was respectively 6.03% ± 0.57% and 5.96% ± 0.53% (elderly), 5.97% ± 0.39% and 5.36% ± 0.57% (young); SI, was 6.20 ± 0.59 × 104 min−1/ (μU/mL) (elderly) and 6.35 ± 0.30 (young); SG was 0.016 ± 0.002 min−1 (elderly) and 0.019 ± 0.003 (young); φ1 was 1.84 ± 0.29 min‐1(μU/mL)/(mg/dL) (elderly) and 3.37 ± 0.84 (young); φ2 was 13.80 ± 1.78 × 104 min−2(μU/mL)/(mg/dL) (elderly) and 9.59 ± 2.65 (young). These results show no change with aging of tissue insulin sensitivity and an intact β‐cell activity, suggesting that age per se does not contribute to the deterioration of glucose tolerance when the insurgence of other age‐relaled variables, eg, obesity and physical inactivity, is precluded.
Religious Activities and Attitudes of Older Adults in a Geriatric Assessment Clinic
Authors: Koenig Harold G. , Moberg David O. , Kvale James N.
Published: April 2015

Few studies have examined the prevalence, salience, and impact of religious beliefs, activities, and commitment among medical patients in later life. Surveys of the U.S. population aged 65 years and over reveal a high frequency of such beliefs and activities, which are reported to play a significant role in their lives. In this study, the religious beliefs, activities, and motivations of 106 consecutive patients (mean age 74.4 years) attending a geriatric outpatient clinic were examined. A high prevalence of orthodox Christian beliefs, religious community activity, private devotional activity, and intrinsic religious orientation was found. Levels of religious activity and intrinsic orientation were lower among patients with cancer, chronic anxiety, depressive symptoms, and those who smoked cigarettes or consumed moderate to large amounts of alcohol. Intrinsic religiosity was lower among men with hypertension. Patients with mild to moderate dementia tended to have higher levels of intrinsic religious orientation. The results of this study suggest that religion is a powerful cultural force in the lives of older medical patients and is integrally related to both mental and physical health.
Why Elderly Patients Refuse Hospitalization
Authors: Barry Patricia P. , Crescenzi Caroline A. , Radovsky Laurie , Kern Donald C. , Steel Knight
Published: April 2015

To identify important factors in the refusal of hospitalization by elderly patients, a study was conducted of 35 such “refusers” on the Home Medical Service (HMS) of University Hospital and a comparison group of 70 patients who accepted hospitalization. Data were collected from health care providers and patient records at entry and six weeks later. The two groups were compared on the basis of demographic factors, health care factors, medical condition, and outcomes. Reasons for refusal were most commonly related to a negative perception of the health care system or a passive acceptance of death. Refusers were significantly less ill than acceptors and did not change in health or functional status at follow‐up. The results suggest that refusal of hospitalization is most often related to interaction with the health care system and that less ill patients may have reasonable outcomes when treated at home.
Benign Paroxysmal Positional Vertigo in the Elderly: Treatment by Habituation Exercises
Authors: Noné M. E. , Beckers A.
Published: April 2015

Exercise treatment has become generally accepted as therapy for some types of vertigo. Benign paroxysmal positional vertigo (BPPV) has been very successfully treated by vestibular habituation training (VHT). This is an exercise treatment whereby the patient is repeatedly exposed to the maneuvers eliciting vertigo. Elderly patients treated by VHT also showed very satisfying results, albeit the therapeutic effect developed somewhat slower than in the younger patients. In the scope of the problem of “falling in the elderly,” the therapeutic effect for BPPV is worth emphasizing.
Behavioral Disturbance in Dementia of the Alzheimer's Type
Authors: Teri Linda , Larson Eric B. , Reifler Burton V.
Published: April 2015

Behavioral problems are thought to be pervasive and devastating to patients with dementia of the Alzheimer's type and their families. Despite this, little empirical data are available concerning the nature of such impairments, their rate of occurrence or their relationship to the disease process. This study investigated 127 patients with a primary diagnosis of dementia of the Alzheimer's type. Two methods of behavioral assessment were employed: a standardized dementia rating scale and a checklist of behavioral problems. Results indicated a) the overall number of problems significantly increased with increased cognitive impairment, b) the types of problems reported varied with cognitive severity, and c) behavioral problems were not significantly associated with patient's age, gender, duration, or age at onset of dementia. These findings are discussed as they relate to the phenomenology of dementia of the Alzheimer's type and to suggestions for interventions at different stages of the disease process. Problems found associated with level of impairment such as wandering, agitation, incontinence, and poor personal hygiene are thought to be characteristic of the disease and therefore predictable. Problems found not associated with level of impairment such as hallucinations, irrational suspicions, falls, and restlessness are likely to be idiosyncratic. The former should probably be incorporated into education and intervention programs; the latter addressed as needed on an individual basis.
Computerized History and Self‐Assessment Questionnaire for Diagnostic Screening among Patients with Dementia
Authors: Rogers Robert L. , Meyer John Stirling
Published: April 2015

In order to standardize and quantify diagnostic information derived from medical histories and case reports given by demented patients, their families or care‐providers, a questionnaire has been developed containing 94 questions. The output is categorized by computer into graphic clinical scales which correlate and weigh information relating to seven of the most common causes of dementia. The present investigation assesses the validity of predictive diagnostic classifications derived from the clinical scales tested on admission by correlating them later with final diagnoses determined independently by thorough clinical evaluation including standard diagnostic tests, computed tomography and nuclear magnetic resonance scans. Results of 101 healthy, neurologically normal, age‐matched volunteers and 140 patients representative of the more common forms of dementia indicate that correct diagnostic identification was: 75% for dementia secondary to Parkinson's disease, 100% for Huntington's disease, 90.2% for Alzheimer's disease, 82.4% for multi‐infarct dementia, 90.0% for posttraumatic dementia, 77.8% for normal‐pressure hydrocephalus and 85.7% for Wernicke‐Korsakoff dementia. Correct diagnostic assignment was highly significant (P < .0005). The screening questionnaire may prove to be a useful and standard diagnostic tool for clinicians and investigators concerned with epidemiology, prevention and treatment of dementia.
Hospital and Medical Care Use by Nursing Home Patients: The Effect of Patient Care Plans
Authors: Mott Peter D. , Barker William H.
Published: April 2015

Although there has been increasing attention to the ethical and legal issues involved in the patient's right to have treatment or hospitalization withheld, there have been few empirical evaluations of programs designed to accomplish that end. Over a 7‐year period, a medical group cared for 110 patients in a skilled nursing facility. After assessing the patients' wishes and the opinions of the personal physicians and nurses, care plans were made specifying whether each one was to receive maximum, intermediate, or comfort care. The hospitalization rate was found to be 79% lower for the patients receiving comfort care. Multiple admissions were unusual. Those patients made no use of outpatient consultants or major diagnostic procedures and had only 14% as many roentgenograms as the patients receiving maximum care. Whereas acute medical and surgical problems and related physician visits were more frequent for the comfort care groups, specific treatment of those problems was withheld far more often. Mortality was twice as great among the comfort care patients, and nearly all of these deaths occurred in the nursing home. It was concluded that the patient's decision to avoid active management can be honored by specific patient plans carefully communicated to all physicians sharing responsibility for that person's care.
Life Prolongation: Views of Elderly Outpatients and Health Care Professionals
Authors: Kohn Martin , Menon Geeta
Published: April 2015

A peculiar dynamic in communication exists between those who are most likely to be involved in life‐prolongation decisions. We found that both the elderly and health care professionals talk about life‐prolongation, but not with one another; that they consider some of the same factors as they think about the life‐prolongation decision; and that most of them believe physicians should be responsible for initiating discussion. However, the physician or health care professional who wishes to avoid crisis situations also is reluctant to broach the issue for fear of unnecessarily alarming or compromising the defense mechanisms of the patient. The patient remains patient, waiting—with fears of dependency, memories of previous life‐threatening experiences, and deep sensitivity for suffering—for the physician to initiate the discussion. Is a mediator such as a family member necessary in these situations? Is the hospital environment not conducive to discussion of less than heroic efforts?
Hearing Impairment as a Predictor of Cognitive Decline in Dementia
Authors: Peters Christie A. , Potter Jane F. , Scholer Susan G.
Published: April 2015

Thirty‐eight patients with dementia of various etiologies were studied longitudinally to determine the change in cognition over time in subjects with and without hearing impairment. Hearing impaired subjects were older (P < .0001), but subject groups were otherwise comparable with respect to living arrangements, medical illness, number of drugs taken, mood, years of education, and cognitive functioning at the beginning of the study period. Decline in cognitive functioning at follow‐up was greater in hearing impaired subjects and this difference persisted after adjustment for the greater age of hearing impaired subjects (P< .009). Further division of subjects by diagnosis showed that only in the Alzheimer's group did hearing impairment predict more rapid cognitive decline at follow‐up.
Meprobamate Use in the Elderly
Authors: Hale William E. , May Franklin E. , Moore Mary T. , Stewart Ronald B.
Published: April 2015

Meprobamate use was studied in an ambulatory elderly population in Dunedin, Florida. All participants taking this medication were mailed a questionnaire concerning their pattern of use. From 2,278 subjects, 30(1.3%) reported the use of this drug. The average age of participants using this drug was 81.3 years. Five participants began using the drug over 27 years ago and over one‐half of the respondents reported using the drug on a regular basis for over 10 years. With this type of history of meprobamate use, one might expect to encounter a large number of patients in the future who, in a similar manner, have been using benzodiazepines for many decades.
Do Drugs Affect the Risk of Hip Fracture in Elderly Women?
Authors: Taggart H. McA.
Published: April 2015

The drugs prescribed for 280 women with hip fractures (mean age 83 years) were compared with those prescribed for 145 women controls (mean age 81 years) as recorded in a family practice age‐sex register. Thirty‐three precent of the fracture patients were taking diuretics compared with 24% of the controls (.10 > P >.05). Forty‐six percent of these diuretics taken by the fracture group (compared with 40% taken by the controls) were either loop or potassium sparing diuretics in combination with another diuretic. Twenty‐five percent of the controls (compared with 9% of the fracture patients) were taking nonsteroidal anti‐inflammatory drugs (NSAIDs) (P < .001). The greater use of NSAIDs by control subjects may be due to the small overlap between osteoporosis and osteoarthritis. No significant differences were found for digoxin, anti‐hypertensive drugs, and those taking no drugs. Thirty percent of fracture patients were taking sedatives and hypnotics compared with 28% of controls. Within this category, 54% of the fracture patients and 80% controls were receiving drugs (mainly benzodiazepines) with half‐lives longer than 24 hours. Thus, this population did not confirm a previously identified association between long‐acting sedatives and the risk of fracture. As only 3.5% of fracture patients and 2.1% controls were receiving phenothiazines, a role for these drugs in hip fracture cannot be ruled out. In summary, hip fracture patients were slightly more likely to be taking diuretics and somewhat less likely to be taking NSAIDs than controls but there were no differences with respect to other drugs.