bluuebunny/crossref_metadata_2025 huggingface dataset:
MECKEL'S DIVERTICULUM IN AN ADULT
Authors: Case Thomas C.
Published: April 2015

Abstract

A case report is presented of an adult male with 3 complications (infection, chronic intestinal obstruction, hemorrhage due to ulceration) of Meckel's diverticulum. The diagnosis of Meckel's diverticulum was made preoperatively on the basis of the history, and the roentgenographic findings corroborated this diagnosis. Treatment is surgical. In this case, the severe inflammatory reaction with induration and thickening of the ileum necessitated resection of part of the ileum along with the diverticulum. Upon discharge from the hospital, the patient was free of all symptoms.
RHEUMATIC DISEASES OF THE AGED: DIAGNOSIS AND MANAGEMENT*
Authors: Paolino James S.
Published: April 2015

Abstract

Case histories are presented to illustrate problems posed by elderly patients with rheumatic disease. When the diagnosis of rheumatoid arthritis or osteoarthritis is established, various medical or surgical measures are applicable (as described). In another group of patients, the differential diagnosis is more difficult, but must be solved before proper treatment can be started.
YOUNGER AT HEART: A STUDY OF THE P‐R INTERVAL
Authors: Cheraskin E. , Ringsdorf W. M.
Published: April 2015

Abstract

With advancing age, the electrocardiographic P‐R interval lengthens. The question arises as to whether this characteristic of the aging process can be regarded as normal or as physiologic. Two hundred and fifty dentists and their wives were studied, before and after an improved dietary regimen. Comparisons were made with Lepeschkin's data on 872 “normal” persons. On the assumption that normal is synonymous with average, there is normally an increase in the length of the P‐R interval. However, the data in this report suggest that a progressively longer P‐R interval with time is not physiologic. Moreover, the trend can be reversed by dietary means. Thus people can be made “younger at heart.”
GENERATIONAL CHANGES AND GERIATRIC CARE*
Authors: KOBRYNSKI BORYS , CUMMING ELAINE
Published: April 2015

Abstract: An increase in variety of care for the disabled elderly and an improvement in quality is long overdue. These changes will be mandatory because of demographic and social trends that are discernible now, but which will not have their effect for some time. Trends which reflect basic changes in life style include: 1) the lower age of marriage and the completion of families in the third decade of life, a fact which predicts that the disabled elderly will have to be cared for by children who themselves are reaching the age of disability; 2) trends toward abandoning “family homes” for small apartments, urbanization and earlier retirement; and 3) the relocation of responsibility for care of the aged to the public sector.

An important factor which has already affected planning for geriatric services is the changing role of state mental hospitals. A large group of the elderly in New York State has received care in the only place available to them—the state hospital—but this has not been adequate. A study of a group of elderly patients screened out of a mental hospital in New York City showed that, after six months, close to 50 per cent were still living at home and nearly 30 per cent were in nursing homes.

Because of demographic and social trends, undue reliance on care in family homes is not advocated. Rather, planning should include new models such as small congregate homes specializing in the care of the confused elderly and a wide range of supportive social services. Greater acceptance of responsibility by local communities is expected, with the state assuming financial support and supervision of the quality of care.
MORTALITY OF AGEING PEOPLE BY SOCIAL GROUPS IN THE GAINFULLY EMPLOYED POPULATION OF BULGARIA, 1965–1966
Authors: MATEEFF D. , STOJNEV G. , VIZEV S. , DOJCHINOVA TZ.
Published: April 2015

Abstract: This study is concerned with mortality in three basic social groups in Bulgaria (both sexes): 1) cooperative farmers, 2) workers, and 3) employees—gainfully employed in 1965 and 1966. The mortality rates for these groups increased in parallel fashion, and were almost the same up to the age period 45–49 years. After this age period the mortality rates rose steeply and the first inter‐group differences appeared; these became even greater with advancing age. Thus, the mortality rate for gainfully employed males over age 60 was 5.5 times higher than for cooperative farmers, and 2.5 times higher than for workers. When causes of death in the 60+ age group were examined, it was found that deaths from cardiovascular disease were 6.5 times higher for employees than for cooperative farmers, and 2.5 times higher than for workers. Similar ratios were found with respect to diseases of the central nervous system and of the respiratory organs. Moreover, deaths from various kinds of tumours were 4 times higher for employees than for cooperative farmers.

The factors leading to such striking differences in mortality for the three basic social groups are discussed. The principal factor apparently is the difference in their regimens of work and life.
COMBINATION MEDICATIONS IN PSYCHIATRIC TREATMENT: PATTERNS IN A GROUP OF ELDERLY HOSPITAL PATIENTS*
Authors: FRACCHIA JOHN , SHEPPARD CHARLES , MERLIS SIDNEY
Published: April 2015

Abstract: The patterns for treatment with combined medications were studied in a group of elderly male (n = 137) and female (n = 432) psychiatric patients housed in the continued‐treatment services of a state hospital. The combination most frequently used was that of an antidepressant agent with a tranquilizing drug (major or minor). Slightly more than half of all combinations of psychoactive agents prescribed for these patients were composed of a tranquilizer and an antidepressent agent.

The combining of particular psychotropic drugs appeared to be related to the sex and age of the patients. Major tranquilizers were used proportionally more often as part of a combination for patients (both sexes) below the age of 70, and proportionally less often for patients aged 70 or older.

Certain drugs—perphenazine, chlorprothixene, diazepam and amitriptyline—were used in combinations much more often for female patients than for male patients. Thus the combinations of amitryptyline with chlorprothixene or perphenazine, and of imipramine with diazepam or perphenazine, were used almost exclusively for females. On the other hand, combinations involving the use of thioridazine with trifluoperazine or imipramine were used more often for male than for female patients.
CHANGES IN THE PHYSICAL PROPERTIES OF HUMAN HAIR WITH AGE
Authors: NARUSE NOBUKO , FUJITA TAKUO
Published: April 2015

Abstract: With the use of Tensilon III apparatus for the measurement of tensile strength, stress‐strain curves were drawn on human capital hair samples obtained from 81 healthy Japanese male subjects whose ages ranged from 2 to 91 years. The diameter of the hair showed a peak at 15 years of age, followed by a gradual decrease with advancing age. The breaking strength rose up to the age of 20 years; then it diminished with advancing age. The per cent extension at breaking and the amount of energy required until breaking also rose up to age 15 and then gradually declined. Young's modulus followed a second‐power function of a gradual fall up to age 15, followed by a gradual rise with advancing age.
ONE‐STAGE MULTIPLE SURGICAL PROCEDURES IN A 91‐YEAR‐OLD MALE
Authors: CASE THOMAS C.
Published: April 2015

Abstract: This case report concerns a 91‐year‐old man in whom the following operations were performed at one time: 1) cholecystectomy (very large gall bladder with a stone in the cystic duct); 2) inguinal herniorraphy (the sigmoid‐pelvic colon was contained in a huge scrotal hernia); and 3) orchiectomy and hydrocelectomy (large hydrocele). The patient had an uneventful recovery. Old age no longer should be regarded as a contraindication to surgery when there is careful attention to necessary medical details and full cooperation between physician, surgeon, and laboratory personnel.
The Basic Philosophy of Estrogen Maintenance
Authors: WILSON ROBERT A. , WILSON THELMA A.
Published: April 2015

The importance of estrogen in the lives of women is stressed. The Maturation Index is a valuable aid in the detection and therapeutic monitoring of estrogen deficiency. The best method of treatment is with naturally occurring estrogens, human or equine. The process is simply the transfer of natural estrogens from one mammal to another, and there are no side effects when given in proper dosage. Such estrogen maintenance can be successfully extended beyond the age of the menopause.
Factors Influencing Sexual Behavior*
Authors: GREENBLATT ROBERT B. , LENG JEAN‐JOËL
Published: April 2015

Among the many factors that shade and color the intensity and direction of human sexuality are gonadal integrity, chromosomal determinants, external genital adequacy, socio‐economic influences, endogenous and exogenous hormonal dependency, and possibly hypothalamic sensitization during fetal life. Neither gonads nor chromosomal sex decide the direction of overt sexual behavior. Libido, in great measure, is a chemical test‐tube equation. Testosterone is the hormone that intensifies sexual drive in both man and woman; it is particularly useful in restoring sexual drive in the woman who once knew, but has lost her libido. Testosterone in the adult female does not alter the direction of sexual behavior or amatory responsiveness. Age need not alter performance nor eliminate the satisfaction and pleasure that attend sexual gratification. Several illustrative cases are presented.
Determinants of Sexual Behavior in Middle and Old Age*
Authors: PFEIFFER ERIC , DAVIS GLENN C.
Published: April 2015

Data are presented regarding the determinants of sexual behavior in men and women aged 46 to 71 years. Stepwise multiple regression analyses were made, involving a variety of physical, psychologic and social measures as independent variables. The level of sexual functioning in younger years, the age and sex of the subject, as well as subjective and objective health ratings, each were found to make independent contributions to the total variance in sexual behavior. A much larger number of variables influenced sexual behavior in men than in women. In women relatively fewer variables — past sexual enjoyment, marital status, and age — were the most significant determinants. These data confirm previous observations that for women the presence of a sexually capable, socially sanctioned partner is a crucial determining influence. Some of the implications of these findings are discussed.
Emotional Factors Contributing to Facial Paralysis
Authors: GOLDBERG MELVIN J. , HARTE SAMUEL
Published: April 2015

In 7 of 44 patients, emotional trauma preceded the onset of facial paralysis. The changes in the facial nerve varied from physiological block to complete degeneration. Detailed historical reviews of the patients' emotional, vocational and marital backgrounds indicated basic inadequacies in their pre‐morbid personalities. All the patients appeared to have adjusted fairly well to their environment; yet, under intense emotional stress, each reacted in a similar manner. Severe anxiety, depression, and symptoms of hysteria were observed on psychological examination. The data suggest that a severe emotional crisis may be an etiological factor in facial paralysis.
Gallstone Ileus: Review of Forty Cases
Authors: SAFAIE‐SHIRAZI SIROOS , PRINTEN KENNETH J.
Published: April 2015

Forty cases of gallstone ileus are summarized in terms of incidence, physical findings and operative therapy. Vomiting with crampy abdominal pain was the chief complaint in the majority, and over half of the patients had a past history of cholecystitis or jaundice. Accuracy of preoperative diagnosis is increased if the physician has a high index of suspicion in the case of elderly patients with small‐bowel obstruction of obscure etiology. Gastrografin or barium upper‐gastrointestinal x‐ray examinations help to outline a cholecystoduodenal fistula or obstructive stone, especially in patients with a high small‐bowel obstruction. Discussion centers on three forms of surgical therapy: 1) enterotomy, 2) enterotomy with interval cholecystectomy and closure of the biliary‐enteric fistula, and 3) total one‐stage repair as an initial procedure. The data and observations confirm the opinion that enterotomy followed by an interval cholecystectomy, or selective total one‐stage repair of the cholecystoduodenal fistula with enterotomy, are the treatments of choice in patients with gallstone ileus.
Carcinomatous Meningitis, with Special Reference to Low Chloride Concentration in the Cerebrospinal Fluid
Authors: YAAR I. , HERISHANU Y.
Published: April 2015

Two patients with carcinomatous meningitis are reported. They had several clinical features in common. Special reference is made to low concentrations of chloride and sugar in the cerebrospinal fluid, and to generalized and localized epileptic attacks. The first patient was treated with nitrogen mustard, and the second underwent bilateral subtemporal decompression followed by cranial irradiation. The results were better than usual, since there was a relatively long survival period of approximately one year, and the second patient is still in satisfactory general condition. The diagnosis of carcinomatous meningitis is discussed.
The Many Faces of Carcinoma of the Pancreas: Case Report
Authors: JANA D. K.
Published: April 2015

A 91‐year‐old woman was admitted to a mental hospital, with a primary psychiatric diagnosis. For two years she had had various abdominal complaints and anorexia, and finally had become “grossly disturbed.” However, the physical, radiological and laboratory findings were not conclusive, although a diagnosis of peptic ulcer was entertained at one time. She became almost completely withdrawn. There was no jaundice until shortly before death, which occurred after twelve weeks in the hospital. Autopsy revealed carcinoma of the head of the pancreas with extensive metastases. This case illustrates the difficulties in differential diagnosis of pancreatic carcinoma, especially when several of the most common features are absent initially and when the picture is predominantly psychiatric.
An Ergot Preparation (Hydergine) for Relief of Symptoms of Cerebrovascular Insufficiency
Authors: BANEN DAVID M.
Published: April 2015

ABSTRACT: Seventy‐eight geriatric patients with symptoms and signs of cerebrovascular insufficiency were treated either with Hydergine or a placebo in a randomized, double‐blind manner for twelve weeks. Changes in the patients' condition were measured in three areas—attitude and behavior, cognitive and intellectual capacities, and clinical status (physical complaints). Analysis of the data revealed that Hydergine most significantly improved items pertaining to the patients' attitude and behavior. No untoward effects were observed.
Vitamin C Therapy in Geriatric Practice
Authors: RICCITELLI M. L.
Published: April 2015

ABSTRACT: Numerous recent reports on the use of high‐dosage vitamin C in the treatment of the sick, injured, and convalescent have created a renewed interest in therapeutic nutrition. This article reviews the metabolism of vitamin C, its role in the maintenance of optimal health, the consequences of vitamin C deficiency, and the need for therapeutic diets in homes and hospitals. Also discussed are modern concepts of the body's adaptation to emotional and physical stress, the effect of stress on aging, and the role of vitamin C in the etiology and treatment of specific disease syndromes, e.g., the common cold, atherosclerosis, nutritional encephalopathies, low‐back pain, surgical stress, hemorrhage, and shock. A new, practical method (Cevi‐Bid sustained medication capsules) is described for maintaining therapeutic levels of vitamin C in the blood.
Salicylate Poisoning in the Elderly: Diagnostic Pitfalls
Authors: PAUL B. N.
Published: April 2015

ABSTRACT: A case is reported of salicylate poisoning in a 77‐year‐old chronically depressed man who was admitted to the hospital in a shock‐like state with cardiac dysrhythmia, respiratory alkalosis and metabolic acidosis. No history was available at the time. He responded to a regimen of hydration, potassium replacement and urinary alkalinization. Salicylate intoxication in an elderly person can mimic “impending” myocardial infarction, viral encephalitis, acute alcoholic intoxication, gastric carcinoma or diabetic keto‐acidosis. Therefore it is essential that the physician know the effects of salicylate on the body systems and also the various clinical spectra of salicylate poisoning. Determination of the blood level of salicylate is extremely important for confirming the diagnosis and for monitoring the effects of treatment.
A Community Home‐Care Program
Authors: LIBRACH GERSHON , DAVIDSON CLAIR , PERETZ ABRAHAM
Published: April 2015

ABSTRACT: The experience of a centrally administered, neighborhood coordinated, home‐care program developed in Israel as an extension of a Health and Welfare Center for the Aged, is described. During the first two years 85 aged, most of them bedfast and home‐bound, were provided with a variety of services by the home‐care team, either directly or by drawing on the different community resources.

Coordinated home‐care programs incorporating an interdisciplinary approach are a valuable and effective component in the community services required for the care of the chronically ill. Such services can help alleviate many of the hardships experienced by these patients and their families. Fewer of these patients need placement in long‐term care facilities, or else their placement can be postponed. The provision of continuity of care helps to reduce re‐admissions to general hospitals, and those admitted have shorter stays, thus permitting a higher patient turnover and better utilization of beds for the care of acute illnesses.
Comments on the Use of Anticoagulants in Geriatric Patients*
Authors: WRIGHT IRVING S.
Published: April 2015

Geriatric patients have a greater per capita need for anticoagulant therapy than do younger patients. They should not be deprived of this therapy when it is indicated, as it is often a life‐saving measure. When used in elderly patients, however, careful control and observation are essential.
Hypothyroidism Mimicking Myotonic Dystrophy
Authors: MARGOLIS JACK , FREITAS W. J. , MARGOLIS LAWRENCE S.
Published: April 2015

In a case of apparent hypothyroidism mimicking myotonic dystrophy the response to thyroid therapy was dramatic and complete. The relationship between hypothyroidism and myotonic dystrophy is discussed.
Age As a Factor in the Referral and Treatment of Psychiatric Patients by Internists*
Authors: GARETZ FLOYD K. , GARETZ DIANE
Published: April 2015

Questionnaires were completed by 153 internists concerning their referral and treatment of out‐patients showing psychologic disturbances. Internists reported that equal numbers of their younger and older patients had psychologic disturbances; in the light of other data, this suggests that such disorders are being overlooked in some older patients. The internists also indicated that they referred equal numbers of older patients and younger patients to psychiatric facilities. Some internists treated psychologic disturbances in younger and older patients to the same degree, whereas cardiologists tended to treat more of the older group, and nephrologists tended to treat more of the younger group.

The age of the physician is an important factor in his practice. Older physicians saw more older than younger patients in their practice. Older internists with certain subspecialty interests perceived psychologic disturbances more often in older patients than in younger patients. Older cardiologists personally treated psychologic disturbances more often in older patients than in younger ones. Individual interests and personalities of the internists were factors in their referral and treatment practices. Some internists referred more patients with psychologic disturbances and others personally treated most of these cases, regardless of the age of the patient.
Aging and the Extrapyramidal System*
Authors: BARBEAU ANDRE
Published: April 2015

The role of the extrapyramidal system in the pathophysiology of aging is reviewed. The clinical, pathological and biochemical evidence points to the involvement of the basal ganglia in the development of senescence; also, the hypothalamus does not respond normally. Many endocrine functions decrease with advancing age, but senescence of the central nervous system precedes that of the endocrine organs. Aging can be considered as a failure in the homeostatic mechanism of the organism. This involves the autonomic nervous system and the neuroendocrine mechanisms in the hypothalamus. Aging of the diencephalon influences the aging process of the whole organism, and is manifested by slowness of movements, defects in speech, thinking and alertness, decreased sexual activity, and changes in the waking/sleep pattern.
Tranquilizing Deep Respiration Test in Essential Hypertension
Authors: FUJII SHIZUO
Published: April 2015

In 20 normal subjects, deep respiration in a quiet supine position lowered the systolic pressure by 3.8 ± 0.6 mm Hg and the diastolic pressure by 2.2 ± 0.5 mm Hg within one minute. In 15 patients with the fluctuating type of essential hypertension, systolic pressure fell by 45.0 ± 4.5 mm Hg and the diastolic pressure by 15.0 ± 1.3 mm Hg during the same procedure. In 15 patients with the fixed type of essential hypertension, the fall of systolic and diastolic pressure was significantly less than in patients with the fluctuating type. Simple plethysmography revealed a definite reduction of vascular resistance in patients with the fluctuating type of essential hypertension but not in those with other types of hypertension and in normal subjects. The deep respiration tests with its tranquilizing effect appears to be of value in demonstrating the neural‐vasomotor component in essential hypertension and in differentiating between the fluctuating and fixed types of the disease.
Fatal Septicemia Due to Providence Group Bacilli
Authors: MILSTOC MAYER , STEINBERG PHILIP
Published: April 2015

There has been an increase in the frequency and severity of infections due to Gram negative bacilli of the Providence group. Eight cases are presented in which these organisms caused septicemia; 6 of the 8 patients died. Infections with Providence bacilli are considered to be nosocomial or iatrogenic. The rapid appearance of resistant bacteria in this group requires more efficient therapeutic agents.
Common Symptoms and Complaints of the Elderly*
Authors: ECKSTEIN DAVID
Published: April 2015

The chief complaints and symptoms of the elderly are discussed under the headings of organically based disorders (visual and auditory impairments, skeletal pain, osteoporosis, dermatologic lesions, disturbances of the urinary tract, heart, brain and digestive tract) and functional disorders (chiefly fatigue and insomnia). Sedatives and tranquilizers may eventually enhance rather than reduce fatigue and insomnia. Appropriate medical therapy is essential for acute illness and for relatively short chronic illness, but the beneficial influence of religious activity should not be overlooked. Most elderly people deserve our confidence and respect for the way in which they have passed the tests of life. Their complaints usually are valid and should be given compassionate and enlightened attention.
Prolongation of the Life Span in Rats
Authors: ODENS MAX
Published: April 2015

To test the effect of RNA‐DNA in preventing the deleterious effects of old age, an experiment was conducted that involved 10 rats with a normal life span of 800–900 days. All were fed the same diet; 5 rats were not treated, and 5 were given weekly injections of DNA + RNA. After twelve weeks the difference in appearance, weight and alertness was remarkable. The 5 untreated rats died before 900 days. Of the treated rats, 4 died at ages of 1600–1900 days, and 1 at 2250 days. A parallel cannot be drawn with aging in human beings fed RNA‐DNA, but the findings on rats may have some application to cellular studies on cancer.
Evaluation of a Comprehensive Psychiatric and Health Care Program for Elderly Welfare Tenants in a Single‐Room Occupancy Hotel*
Authors: PLUTCHIK ROBERT , McCARTHY MARTIN , HALL BERNARD H. , SILVERBERG SHIRLEY
Published: April 2015

This report concerns the evaluation of a program for elderly welfare recipients and for patients discharged from state hospitals and sent to live in a single‐room occupancy hotel in New York City. Descriptions are given of: 1) the hotel, 2) the funding of the program and the staff, 3) the program and its various aspects, and 4) the objectives. The evaluation is based on the results of an intensive survey conducted for the period January‐June 1972. Of the 299 tenants, 181 provided the detailed information. About 87 per cent of the tenants (mean age, 59.1 years) were supported in full or in part by welfare; only 4 per cent were currently married; 18 per cent had some college experience; and the mean length of tenancy was about four years. There was a distinct increase each month in the tenants' use of medical, psychiatric, recreational and social services. Thus it is not always possible to plan the program requirements in advance because of abrupt situational changes.

This hotel project is offered as a model for the development of a comprehensive treatment and rehabilitation program for elderly welfare tenants and psychiatric patients living in urban hotels. The aim is to improve the quality of life for the tenants and to establish a sense of community and personal autonomy among them.
Hypernatremic Psychosis in the Elderly: Case Reports
Authors: JANA D. K. , ROMANO‐JANA L.
Published: April 2015

Hydropenia with hypertonicity and Hypernatremia may sometimes give rise to psychomotor restlessness and a confusional state in elderly patients. On admission to a mental hospital, a psychiatric diagnosis may be made and the hypernatremia overlooked. Four such cases are reported. On admission the patients were ambulatory. There were no localizing neurologic signs, no history of acute illness, and no sensation of excessive thirst. Blood studies revealed hypernatremia. With intravenous administration of hypotonic fluids, the confusional stage cleared up. As there was no evidence of primary cerebral, renal or endocrine lesions, apparently there was no primary derangement of the mechanisms for regulating sodium and water.
Serum Lipids, Serum Uric Acid and Glucose Tolerance in Coronary Heart Disease*
Authors: ARONOW WILBERT S. , UYEYAMA RONALD R. , CASSIDY JOHN
Published: April 2015

In 100 patients (mean age, 51) with angina pectoris due to coronary heart disease (documented), determinations were made of the serum cholesterol, triglyceride and uric acid levels on two separate days at least two weeks apart; also (in the absence of fasting hyperglycemia) glucose tolerance tests were performed after oral administration of 100 gm of glucose. In 95 per cent of the 100 patients, the serum cholesterol level was above 200 mg/100 ml. In 51 per cent there was hypertriglyceridemia. In no patient was there hypertriglyceridemia in association with a serum cholesterol level below 200 mg/100 ml. Thirty‐five per cent of the 100 patients showed abnormal glucose tolerance. Eleven per cent of the 100 patients had hyperuricemia. An elevated concentration of serum cholesterol was the most common metabolic abnormality associated with angina pectoris due to coronary artery disease.
Long‐Term Results with Oral Hypoglycemic Drugs
Authors: MOSS JAMES M. , DeLAWTER DeWITT E.
Published: April 2015

An analysis was made of the records of 1,840 patients in whom diabetes started after the age of 35 and before the age of 70, and who were under the authors' care for from one to fifteen years. According to the predictions of life‐insurance tables, these patients lived longer than non‐diabetic patients. There was a significant decrease in longevity in those who had persistent hyperglycemia. The greatest increase in longevity occurred in those whose disease could be controlled by diet alone or with sulfonylurea drugs. There was less apparent benefit from phenformin or insulin in this respect. In comparison, the findings of the University Group Diabetes Program are discussed in some detail. The authors' data indicate that, in the treatment of diabetes, sulfonylurea drugs have a beneficial effect upon longevity when they are used properly.
Elderly Women in Institutions versus Those in Public Housing: Comparison of Personal and Social Adjustments
Authors: ABDO EDMUND , DILLS JOSEPH , SHECTMAN HARRIET , YANISH MARY
Published: April 2015

An investigation was made of the comparative effects of living in urban public housing or a suburban nursing home upon the personal and social adjustment of elderly women. Structured personal interviews were held with 20 residents in each setting. The Kutner Morale scale and a Socialness scale designed for this study were used. The findings indicated that there existed: 1) a statistically significant difference in the personal and social adjustments between the two populations, with the public‐housing elderly achieving higher mean scores; 2) a significant relationship between the personal and social adjustment of individuals within each residential setting; and 3) a strong positive relationship between health and social adjustment in the public‐housing population. It was tentatively concluded that the female elderly in public housing showed higher adjustment than did the female elderly in the nursing home. Factors which may have influenced these findings were the nursing home's comparative lack of privacy, independence of action and nearness to friends, relatives and the community. It is recommended that future research in this area be carried out for the aged in all types of residence.
Medicine in Modern China*
Authors: CHENG TSUNG O.
Published: April 2015

The Chinese‐born author gives an illustrated account of his visit to China in 1972, twenty‐two years after he left that country in 1950. For the first time in her history China appears to be self‐sufficient in taking care of the medical needs of her people. Among the many medical developments are the revitalization of traditional medicine, the emergence of “barefoot” doctors, the synthesis of insulin, the successful rejoining of severed limbs and fingers, family planning, the management of extensive burns, the successful treatment of choriocarcinoma by chemotherapy, and acupunctural anesthesia. Of great significance is the apparent increase of coronary artery disease among the Chinese. Whether the increased incidence is relative due to more accurate diagnosis and longer life expectancy, or absolute due to better nutrition and perhaps over‐eating, is not yet certain. In contrast, the incidence of lung cancer has not shown an increase despite the prevalence of cigarette smoking among the Chinese. Cancer is one of the major killers; a constant campaign is waged for the early discovery of malignant tumors. Despite the twenty‐three years of isolation, medicine in China is as modern as that in the United States, and physicians still speak the same language.
Diagnosis and Treatment of Common Eye Diseases in the Aged: Guidelines for the Practicing Physician*
Authors: KORNZWEIG ABRAHAM L.
Published: April 2015

ABSTRACT: Several common eye diseases in the aged can be diagnosed and treated by the practicing physician. Techniques for eye examination are outlined. Both distant and near vision should be tested in any patient complaining of visual disturbances. Cataract formation is the most common cause of visual loss in the aged. When necessary, cataract surgery should be performed regardless of the patient's age or many physical ailments. Practicing physicians should make a determined effort to detect cases of glaucoma and start the treatment that may prevent blindness. Macular disease, although difficult to treat, often can be helped by low‐vision aids. Occlusions of the central retinal artery or vein are emergencies and should be referred to the ophthalmologist as soon as possible.
Problems in Geriatric Health Care Delivery*
Authors: McGLONE FRANK B. , SCHULTZ PHYLLIS R.
Published: April 2015

Innovations in the delivery of health care have not kept pace with advances in medical knowledge and techniques. An increase in population and an increase in the ability to pay have turned the need for health care into a demand for health care. There has not been a concomitant increase in the number of physicians trained for geriatric medicine or interested in geriatric care. The very nature of the management of chronic disease demands a re‐allocation of responsibilities so that the physician's unique capabilities can be better utilized. This calls for a change in our present system of health care delivery. Quantity, quality, availability and cost are important factors in planning. Primary care can be delivered by a physician‐nurse team responsible for the total care of the patient. The nurse can organize a coordinated approach. Thus the care of the geriatric patient can become a rewarding field of endeavor that should enlist the support of young physicians, nurses and paramedical personnel.
Rehabilitative Psychiatric Nursing for Chronically Ill, Elderly Patients
Authors: GELPERIN EVE ARLIN
Published: April 2015

A trial of psychiatric nursing was made with a group of 21 female patients drawn from the wards of a 2000‐bed chronic disease and rehabilitation facility. At the end of the two‐month period, the study patients were greatly improved in behavioral and intellectual functioning compared to the control group. The chief factor was the establishment of trust in the psychiatric nurse. This was enhanced by the nurse conveying feelings of interest and affection by occasionally touching the patients for this purpose. No threatening demands were made of the patients in the one‐to‐one and group meetings. Plans were made through mutual cooperation, and resulted in a re‐awakening of the patients' desires to be responsible, productive and useful.
The Role of the Medical Director in the Nursing Home*
Authors: SHAUGHNESSY MARY E.
Published: April 2015

The medical director's role in the nursing home will continue to be a crucial one, but because of the limited availability of physicians, this role should be redefined realistically to insure economical and appropriate use of physicians' services. The roles of administrator and of director of nursing services also need redefinition for effective use of their disciplines and to avoid confusion in their functions. The nurse's role should be expanded because of the needs of the patient and the availability and competency of nurses to care for the aged and chronically ill. This would result in better use of the services of both physicians and nurses. The members of all three disciplines should collaborate in redesigning the nursing home programs to meet the intense and complex needs of the patients.
Papaverine—Safety in Use
Authors: GILLISS MARCUS R.
Published: April 2015

ABSTRACT: Reports of isolated uncontrolled studies suggest the frequent occurrence of a hepatosensitivity reaction to papaverine. However, there is a long history of use of this drug, with an excellent record for safety. In view of this conflict of opinion, a controlled study was undertaken. In a double‐blind investigation lasting for four to five months, 29 elderly patients in a state mental hospital were treated with papaverine, and 32 received placebo. There was no significant change in the levels of serum alkaline phosphatase, transaminase or bilirubin. Hepatosensitivity to papaverine, if it does exist, apparently is rare.
Federal Government Involvement in Training Medical Directors of Long‐Term Care Facilities*
Authors: ISACK ARTHUR G.
Published: April 2015

ABSTRACT: The Community Health Service works to organize resources and deliver health services through coordinated federal, state and local programming. Several nursing home programs are listed. The role of medical director of long‐term care facilities is discussed, particularly with reference to AMA seminars on the subject. The federal government has an increasing responsibility for assuring quality in long‐term medical care.
Mortality of the Aged with Chronic Brain Syndrome
Authors: PECK ARTHUR , WOLLOCH LEON , RODSTEIN MANUEL
Published: April 2015

ABSTRACT: The five‐year survival rates for a group of aged persons in a home and hospital for the aged showed that those with chronic brain syndrome (CBS) died at a much higher rate than those without CBS. Bronchopneumonia predominated as the cause of death among those with CBS but not among those without CBS. The mortality for 145 subjects was computed by relating the actual number of deaths to the expected (life tables) number of deaths as a function of age and sex of residents in the same institution. Differences, on the basis of presence or absence of CBS, were statistically significant for females irrespective of whether they were in relatively poor, or relatively good physical condition.
Testosterone in High Dosage for the Treatment of Impotence: Effect on Serum FSH When Combined with Chorionic Gonadotropin: Case Report
Authors: STERNBERG JOSHUA L.
Published: April 2015

ABSTRACT: A 49‐year‐old man was treated for impotence with human chorionic gonadotropin (hCG) alone and then with hCG and testosterone simultaneously. HCG suppressed follicle‐stimulating hormone (FSH) in the serum, testosterone alone also suppressed FSH, but the combined medication increased FSH. The successful treatment of impotence with exogenous testosterone may require the maintenance of higher‐than‐normal levels of serum testosterone, and therefore dosages higher than those used conventionally.
Possible Rationale for Procaine (Gerovital H3) Therapy in Geriatrics: Inhibition of Monoamine Oxidase
Authors: MacFARLANE M. DAVID
Published: April 2015

ABSTRACT: Gerovital H3, a specially formulated preparation of procaine hydrochloride, has been employed for several years in the treatment of various manifestations of aging. Heretofore, there has been no pharmacologic basis for its use in geriatric patients, although procaine hydrochloride and inhibitors of the enzyme, monoamine oxidase (MAO), are known to have many of the same pharmacologic actions. The relative effectiveness of Gerovital H3, commercial procaine hydrochloride (Novocain), and iproniazid as MAO inhibitors was studied by means of tests involving serotonin and kynuramine metabolism by rat‐brain MAO. Gerovital H3 was a more effective MAO inhibitor than commercial procaine hydrochloride but was a less effective inhibitor than iproniazid. Moreover, Gerovital H3 seemed to have a selective affinity for certain of the multiple forms of MAO. These results, in view of the recent observations on MAO levels and aging, may offer a rationale for Gerovital H3 therapy in the elderly.
Status of Patients in an Inner City Nursing Home: Implications for Psychiatric Consultation
Authors: YUDIN LEE W. , DIAMOND HERBERT , TUCKER KAREN
Published: April 2015

ABSTRACT: The residents of an inner city nursing home were studied to ascertain the status of psychiatric consultation and rehabilitative programs. Most of the patients had psychoses associated with organic brain syndromes or senile dementia. The Home was as well run as most such institutions but the record‐keeping was so poor that formal evaluation of the patients was almost impossible. It was clear, however, that there was a great need for continuing psychiatric consultation and the development of appropriate remedial programs that reach beyond custodial care.
Geriatrics and Gerontology in Medical Education*
Authors: BAYNE J. R. D.
Published: April 2015

Despite exhortations in the geriatric literature, medical faculties have not included geriatric medicine in curricula to any significant extent. The establishment of professorships in geriatrics in a few medical schools may have had some local effect but has not spread widely. Rather than continue the exhortations, the explanation for this recalcitrance should be sought and new approaches tried. Recently the trend in medical teaching has been away from didactic lectures and towards student self‐teaching, with earlier specialization including family medicine. Should Geriatrics be identified at an early stage of students' training with a view to producing a small number of geriatric specialists, or should the principles, attitudes and relevant information about the aging process, preventive and preservative measures and management be identified and promulgated by many teachers in different ways? The latter approach is being followed at McMaster Health Science Division and the teaching program is being developed in cooperation with other members of the faculty. This is appropriate to that system which emphasizes self‐teaching, problem solving and small‐group learning without lectures and without formal examinations, but could perhaps be adapted to any system and be better accepted in current teaching philosophy.
The Longevity of Cultured Human Cells*
Authors: HAYFLICK LEONARD
Published: April 2015

ABSTRACT: Research in aging is now becoming firmly rooted in the scientific method. If it receives the support it deserves, it may produce the next major advance in biology. This article summarizes some of the biological aspects of the field including hypotheses, the aging of cultured human cells, the inverse relationship between donor age and cell longevity, the senescence of cultured normal cells derived from different animal species, the latent period of explanted cells versus donor age, progeria and Werner's syndrome, and the future of gerontological research. Life expectancy at birth has increased in recent years, but at age 65–70 it has remained virtually fixed. The human lifespan will not be changed significantly until the underlying biological causes of senescence are slowed or stopped. Since support for research in this field is almost non‐existent, it is more important to concentrate our efforts on increasing research support for gerontology than on increasing the mean lifespan of man. Without the former, the latter will never be improved.
Experiences with the Repair of Groin Hernia in 200 Patients Aged 70 or Older*
Authors: PONKA JOSEPH L. , BRUSH BROCK E.
Published: April 2015

ABSTRACT: A survey was made of the records of 200 patients (158 men and 42 women) aged 70 or older who had undergone repair of groin hernias. In the aged women, femoral hernias were the most common; indirect hernias were seen much less frequently, and there were no direct hernias. In the aged men, large indirect sliding inguinal hernias and simple indirect inguinal hernias were the most common; direct inguinal hernias were seen less frequently than expected. The most serious and easily overlooked complication of hernia, particularly in old women, is bowel strangulation in association with femoral hernia. The operative procedures were individualized and varied. Local anesthesia was used for all poor‐risk patients and was the method of choice in 185 of the 200 patients. A 1% solution of chlorprocaine was the preferred anesthetic agent.

The important complications included wound infection in 7 cases and seroma in 7 cases; infection occurred most frequently in association with gangrenous bowel in the hernial sac. As would be expected, urinary‐tract complications were common since nearly half of the men had benign prostatic hypertrophy. One death occurred in the immediate operative period (third postoperative day) from a cerebrovascular accident. Other deaths after postoperative intervals ranging up to fifteen years were caused by concurrent diseases and seemed unrelated to the hernial operation. The postoperative recurrence rate for hernia was 2 per cent. Surgical repair of groin hernia in aged patients can improve the quality of their lives, and in certain cases (e.g., bowel strangulation) can be a life‐saving measure.
Alterations in the Body Composition of Adult Men during Selected Physical Training Programs
Authors: MISNER J. E. , BOILEAU R. A. , MASSEY B. H. , MAYHEW J. L.
Published: April 2015

ABSTRACT: Twenty‐four adult men were assigned to an experimental weight‐training group (N=10), or to an experimental jogging group (N=8), or to an active control group (N=6). Height, weight, skinfold thickness (ten sites), girth (four sites), and total body potassium (4 0 K) were assessed before and after the exercise programs. After eight weeks of training, the weight‐training group had gained significantly more weight than the jogging group had lost, the jogging and weight‐training groups had lost significantly more fat than the control group, and the weight‐training group showed an increase in fat‐free weight which was significantly different from the changes in fat‐free weight for the other two groups. There were no differences between the three groups for any of the skinfold or girth measurements. Thus adults, given a constant diet, can favorably alter their fat‐free weight and fat weight by participating in regular physical exercise, under adequate medical supervision.
Carcinoma of the Thyroid in Patients Aged 50 or Older*
Authors: HOFFMAN ELMER
Published: April 2015

At the Sinai Hospital of Baltimore, carcinoma of the thyroid was studied in 60 patients whose ages ranged from 50 to 79 years (Series AA). Data on the author's Series A (185 patients of various ages) and data from reports in the literature (children or adults of various ages) are used for comparison. Carcinoma of the thyroid is fairly common in the 50+ age group, constituting 32 per cent of the cases in patients of all ages (Series A). In the patients aged 50 or older (Series AA), the ratio of females to males was 5.7:1.0 versus 3.9:1.0 for patients of all ages. The thyroid carcinoma was multifocal in 18 per cent of the elderly patients. It was found incidentally upon physical examination in almost two‐thirds of the cases. Radioiodine tracing was of little help diagnostically. The best criterion for diagnosis is a high index of suspicion on the part of the physician. If thyroid nodules are treated aggressively, carcinoma can be diagnosed earlier. Often a preoperatively palpable nodule is not the one identified microscopically as containing carcinoma. Frozen‐section diagnosis can be misleading; in 46 per cent of Series AA, the frozen section was reported as benign whereas the permanent sections were reported as carcinoma. The treatment of choice is total thyroidectomy followed by radioiodine therapy if any foci of carcinoma are found by postoperative scanning. Prophylactic removal of lymph nodes is of no value. Thyroid substitution therapy should be started as soon as possible after operation. With use of the author's methods, postoperative tetany and vocal cord paralysis can be avoided. The mortality rate for thyroid carcinoma in the 60 patients of the 50+ age group was 25 per cent. Of the 15 deaths secondary to metastases, 7 were from solid or anaplastic, 5 from follicular, and 3 from papillary or mixed papillary carcinoma. Thus the papillary type is not always benign, as described by some authors. Thirty of the 60 patients were traceable five or more years after surgery. Of these, 10 had died from thyroid carcinoma, 1 had died from another cause, and 3 were alive but with metastases; however, 16 were alive and free of thyroid carcinoma.
Menopausal Headaches—Psychogenic or Metabolic?*
Authors: GREENBLATT ROBERT B. , BRUNETEAU DANIEL W.
Published: April 2015

Constant, adequate dosages of estrogen, androgen or estrogen‐androgen combinations provide relief from the migraine and migrainoid headaches often experienced by menopausal women. This form of therapy employs natural physiologic hormones in preference to synthetic nonphysiologic agents such as ergotamines, barbiturates or addictive drugs. In the author's studies of hundreds of women with menopausal headaches, such hormones administered by pellet implantation gave beneficial results superior to those obtained by oral or parenteral administration.