bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and Correlates of Incontinence in Stroke Patients
Authors: Brocklehurst J. C. , Andrews K. , Richards B. , Laycock P. J.
Published: April 2015

The incidence of incontinence in a series of 135 consecutive stroke patients was 51% (urine) and 23% (feces) within one year. In 75% the urinary incontinence started within the first two weeks, and in 41% it had cleared during that time. Incontinence at onset is associated with measures of severity of stroke (and of immobility for fecal incontinence). Among 92 survivors at one year, 15% were incontinent of urine, a proportion that rose in two‐ and three‐year survivors to 23 to 24%, but by four years was again 14%, a level similar to that of the general elderly population. It is concluded that incontinence is more commonly a by‐product of immobility and dependency than of involvement of the neurologic pathways, and most of it is transient. J Am Qeriatr Soc 33:540, 1985
A Case–Control Study of Maternal Age in Alzheimer's Disease
Authors: English Dallas , Cohen Donna
Published: April 2015

A case–control study of maternal age as a risk factor for Alzheimer's disease was conducted in Washington state. Clinically diagnosed cases of Alzheimer's disease (n = 64) were identified from two sources, an outpatient clinic at the University of Washington and an organization of relatives of patients with Alzheimer's disease. Controls were spouses of the Alzheimer's disease cases and spouses of 87 patients with Parkinson's disease, also identified at the University of Washington. Mail questionnaires were sent to all subjects; responses were received for 90 cases and 96 controls, although nine of those cases, whose medical records of diagnostic evaluations were incomplete, were excluded. Among the 69 cases and 94 controls whose mothers' ages were known, there was no evidence that the mothers of cases were significantly older than the mothers of controls (chi‐square test for trend, P = 0.82). These findings do not support the theory that persons born to older mothers are at increased risk of developing Alzheimer's disease.
Obscuring Urinary Incontinence
Authors: Starer Perry , Libow Leslie S.
Published: April 2015

To assess the prevalence, evaluation, and treatment of urinary incontinence in an institutionalized elderly population, the charts of 511 residents in a New York City nursing home were reviewed. Whereas the nurses' notes documented urinary incontinence in 62.4% of the total resident population, the physicians' notes listed this as a problem in only 10% of the residents. Most (90.3%) of the cases of incontinence were not classified as to etiology or pattern. Treatment emphasized the use of diapers in 78.2% of the cases, which was combined with bladder conditioning in most instances. This treatment approach had been initiated, administered, and monitored by the nursing staff. Indwelling catheters were used in 4.0% of the situations, and pharmacologic therapy was used in 2.5% of the cases. It is suggested that adult diapers may not be the optimal treatment for urinary incontinence since they treat the symptom instead of the cause. There should be a systematic approach to the classification and treatment of urinary incontinence prior to the long‐term utilization of diapers. J Am Geriatr Soc 33:842, 1985
Medical Students' Attitudes Toward Sexually Active Older Persons
Authors: Damrosch Shirley P. , Fischman Susan H.
Published: April 2015

There are widespread assumptions in the literature concerning general disapproval of sexual activity in older persons. However, research evidence in support of these assumptions is sparse. An experiment that focused on attitudes toward sexually active older persons was conducted with 140 freshmen medical students. Each student read a 200‐word account of a 68‐year‐old man or woman temporarily living in a nursing home. By random assignment, half read that the person was sexually active; there was no mention of sexuality for the remaining students. Students evaluated the 68 year old on a rating scale of 0 to 9 for such characteristics as mental alertness and cheerfulness. Regardless of the 68‐year‐old person's gender, the students were significantly biased in favor of the sexually active person. Implications of these findings are discussed. J Am Geriatr Soc 33:852, 1985
Academic Affiliation With a Nursing Home: Impact on Patient Outcome
Authors: Jahnigen Dennis W. , Kramer Andrew M. , Robbins Laurence J. , Klingbeil Heidi , DeVore Patricia
Published: April 2015

In a prospective study, 46 patients discharged from a teaching hospital to a “teaching unit” nursing home, where primary medical care was provided by faculty geriatricians, medical students, and medical housestaff, were compared with 78 similar patients discharged to one of five community nursing homes without a teaching affiliation. At the time of hospital discharge, patients were determined to have a terminal, rehabilitative, or long stay prognosis based on a review of hospital discharge summaries using specific criteria. Among 34 study and 55 control patients with a long stay prognosis, ten of the study group compared with seven of the control group returned home (P = .03). Seven of 34 long stay patients in the study group were rehospitalized, while 15 of a matched control group of 34 required hospitalization (P = .04). There was no increase in mortality or emergency service use in the study population. Patients considered to be terminal or rehabilitative showed no difference in ultimate outcome or hospital use. In the study group patients experienced an average reduction in total medications prescribed from 6.2 to 5.3, while patients in the control group had an increase from 5.4 medications prescribed to 7.6 (P < .001). Of 16 study patients discharged from the teaching unit nursing home, all remained home at least three months after discharge; only 12 of 18 control group patients discharged from the nursing home remained at home at three months (P < .01). Long‐term care by geriatric faculty, students, and housestaff appeared to have favorably influenced patient outcomes.
Evaluation of Urinary Catheterization and Urinary Incontinence in a General Nursing Home Population
Authors: Ribeiro Brian J. , Smith Stephen R.
Published: April 2015

The medical records of 412 residents of three southeastern Massachusetts nursing homes were reviewed to examine the frequency and medical management of urinary incontinence and the indications for chronic urinary catheterization. The mean age of the patients was 84.1 years. In this study 9.7% of the patients were managed with a urinary catheter, while an indication for catheterization was recorded in the medical records of only 27.5% of these patients. Half of the noncatheterized nursing home patients were transiently or permanently incontinent of urine, but were not catheterized. Incontinent patients without catheters were more likely to require assistance in toileting (75.5 v 26.1%) or to have bacteriuria (60.1 v 26.1%) than continent patients. Despite the frequency of urinary incontinence, this problem was included in the medical problem list of less than 5% of the incontinent nursing home patients. The authors conclude that urinary incontinence is a frequent medical problem in the nursing home population, but it is rarely recorded and evaluated as a medical problem. Furthermore, indications for urinary catheterization frequently are also not recorded. An explanation for this practice was not determined, but possibilities include a lack of physician knowledge of the evaluation and management of incontinence and a nonaggressive approach to such patients, given their other medical problems.
Physicians' Knowledge of Prescribing for the Elderly
Authors: Ferry Margaret E. , Lamy Peter P. , Becker Lome A.
Published: April 2015

The 143 physicians who returned to Temple University Medical School a questionnaire on knowledge of prescribing for the elderly constituted 25% of a stratified random sample of general practitioners (GPs), family practitioners (FPs), and practitioners in internal medicine (IMs) reimbursed under Medicare in Pennsylvania in 1979. The mean score on the 23‐item drug questionnaire was significantly lower (P < .05) than the score deemed adequate by a panel of six experts in the field.

Five variables, identified by survey questions, were positively associated with physicians' test scores: importance of professional meetings, perception of need for continuing medical education, board eligiblity/certification, group practice, and a practice in which the elderly constitute 25 to 49% of all patients. Two variables were negatively associated: number of years since date of licensure and the importance of drug advertisements.

Respondents and nonrespondents were compared on nine variables for which American Medical Association (AMA), American Osteopathic Association (AOA), or Blue Shield data were available. Pennsylvania graduates were significantly overrepresented in the respondent group. The only other significant difference found was in field of practice, where findings differed by source of information. There was no significant difference in mean scores of early and late respondents.

The research findings support those of three previous studies, not limited to the elderly, which found prescribing knowledge inadequate. They suggest the need for examining/improving the opportunities for medical students and physicians to increase their knowledge of geriatric pharmacology.
Mental Health of the Elderly: Use of Health and Mental Health Services
Authors: German Pearl S. , Shapiro Sam , Skinner Elizabeth A.
Published: April 2015

The utilization of services by older patients with mental morbidity is examined in this paper. The population is drawn from a large, multi‐site study, the Epidemiological Catchment Area studies, and reports on the findings from the Baltimore, Maryland, site, The Eastern Baltimore Mental Health Survey. The fact that older individuals with mental disorders are less likely to be seen and treated for these disorders than are younger individuals was substantiated by data from this study. Of those under age 65, 8.7 per cent have made a visit to a specialty or primary care provider for mental health care; for those age 65 to 74, the rate is 4.2 per cent, and of those 75 and over, only 1.4 per cent have had such care. In this last group, 75 and over, not a single person saw a specialty mental health provider. The likeliest source of care for older individuals for emotional or psychiatric problems is their primary care providers within the context of a visit made for physical medical problems. Past work and these data suggest that the factors that influence this low level of care can be found in the characteristics of the population as well as in the characteristics of the health care system. The implications of these findings are discussed.
Longitudinal Studies on the Rate of Decline in Renal Function with Age
Authors: Lindeman Robert D. , Tobin Jordan , Shock Nathan W.
Published: April 2015

Serial creatinine clearances (5 to 14 studies) were obtained for 446 normal volunteers in the Baltimore Longitudinal Study of Aging followed between 1958 and 1981. When those subjects with possible renal or urinary tract disease and subjects on diuretics and antihypertensives were removed from the study, leaving a group of 254 “normal” subjects, the mean decrease in creatinine clearance was 0.75 ml/min/year. The slopes of the creatinine clearance vs. time fell into a normal (Gaussian) distribution around this mean. One third of all subjects followed had no absolute decrease in renal function (positive slope of creatinine clearance vs. time) and there was a small group of patients who showed a statistically significant increase (P < 0.05) in creatinine clearance with age.
Visual Perception Dominance of Fallers Among Community‐dwelling Older Adults
Authors: Tobis Jerome S. , Reinsch Sibylle , Swanson James M. , Byrd Mark , Scharf Ted
Published: April 2015

The authors postulated that older adult fallers show a greater tendency than older adult nonfallers to rely more on visual information sources in maintaining upright posture than on kinesthetic and vestibular cues. This paper presents descriptive statistics on 199 older adults living independently in the community. Their visual perception of the vertical and horizontal was analyzed with respect to age, sex, health status, and severity of injury as a result of a fail. The finding of significant impairments for fallers in visual perceptual abilities confirmed a trend previously established by one of the authors (Tobis). When the visual field entailed only misleading or ambiguous cues in the form of a tilted frame, fallers again showed a larger error than nonfallers in establishing the vertical and horizontal. The authors feel that this relatively greater dependence on visual sources may develop in response to impairment of feedback on posture and gait from the kinesthetic and vestibular systems as a result of age and chronic health problems. Errors in visual perception of the vertical and horizontal intercorrelated with age, sex, and a large number of medical problems. However, visual variables were more important in predicting faller status than physical characteristics.
Relationship in Very Elderly Veterans of Nutritional Status, Self‐perceived Chewing Ability, Dental Status, and Social Isolation
Authors: Gordon Steven R. , Kelley Susan L. , Sybyl Judy R. , Mill Mary , Kramer Andrew , Jahnigen Dennis W.
Published: April 2015

The relationship of nutritional status, self‐perceived chewing ability, dental status, and social isolation was examined. Seventy‐three ambulatory, elderly (x̄ = 86 years) veterans were studied. Parameters of nutritional status included intakes of protein, carbohydrate, fat, and total calories, and hemoglobin, serum albumin, total lymphocyte count, and height/weight ratio were determined. Dental status was measured, and self‐perceived chewing problems and social isolation were assessed by interview. Results showed a significant correlation between perceived chewing problems and diminished protein and total caloric intake and increased carbohydrate intake. No association was found between measured dental status and nutritional status. Social isolation was weakly correlated with greater protein and calorie intake. These results support the contention that the presence of self‐perceived chewing problems are more reliable than the quality of the dentition itself as an indicator of altered nutritional status.
The Use of Quality‐of‐Life Considerations in Medical Decision Making
Authors: Pearlman Robert A. , Jonsen Albert
Published: April 2015

Quality‐of‐life considerations in physicians' decisions on life‐sustaining therapy were explored using a patient management problem (PMP) depicting acute respiratory failure in an elderly man with chronic pulmonary disease; 205 internal medicine and family medicine physicians were interviewed. The physicians' perceptions of the patient's quality of life demonstrated marked variability. Physicians considered the patient's quality of life more often to support decisions to withhold therapy than to support decisions to use mechanical ventilation (p < 0.01). Consideration of quality of life was associated significantly with several PMP components: interpretation of the patient's prior medical experience, management of supplementary case information, attitudes about medical responsibilities/patient rights, and estimates of the patient's survival time. The authors conclude that consideration of quality of life in making life‐and‐death treatment decisions may involve judgments about the value of life, and that responsible consideration requires guidelines grounded in ethical principles.
Physicians' and Families' Perspectives on the Medical Management of Dementia
Authors: Glosser Guila , Wexler Debra , Balmelli Marie
Published: April 2015

The role of physicians in the long‐term management of patients with the primary diagnosis of progressive dementia was investigated by surveying the opinions of 57 physicians and 47 family members. Respondents were asked to evaluate the difficulty and helpfulness of various activities physicians perform in the diagnosis, treatment, and management of patients with dementia. Both physicians and families rated the diagnostic services provided by physicians very highly. Although families found physicians' explanations of the diagnosis and prognosis extremely helpful, physicians reported this as an area of difficulty. Physicians and families expressed considerable frustration with the limited medical treatments and interventions for the relief of symptoms associated with dementia. Despite the acknowledged sensitivity of physicians to the social‐psychological consequences of dementia, physicians were found to be least helpful in addressing these issues, either directly or through referral to allied health and social services. This study outlines areas of physician education that need improvement and calls for development of an interdisciplinary network of services for the biopsychosocial management of dementia. J Am Geriatr Soc 33:383, 1985
The Role of Lumbar Puncture in the Evaluation of Dementia: The University of Pittsburgh Study
Authors: Hammerstrom Douglas C. , Zimmer Ben
Published: April 2015

In a retrospective study of 80 patients over 55 years old, the efficacy of lumbar puncture in evaluating elderly demented patients was examined. Despite a cost of $381 per procedure, in addition to cerebrospinal fluid (CSF) evaluation, no diagnosis was made on the basis of the information obtained in any of the patients (53 per cent) who underwent lumbar puncture. The only abnormalities found were 11 cases of nonspecific elevations in CSF protein and one case of abnormal cellularity not related to bacterial infection. An additional 422 cases of dementia from other series were reviewed, and only four patients were found whose diagnosis could have been made by lumbar puncture—one patient had neurosyphilis, and the other three were postencephalitic. In addition, the literature on complications of lumbar puncture was reviewed. There were no serious complications of lumbar puncture in the present study. The authors concluded that although it is low‐risk, lumbar puncture cannot currently be recommended for routine use in the evaluation of elderly demented patients, but should be used in evaluating demented patients under 55 years of age, patients with rapid onset or progression of dementia, patients with syphilis serology in suspected cases of viral encephalitis, and patients with signs and symptoms of fungal meningitis. J Am Geriatr Soc 33:397, 1985
Red Blood Cell Abnormalities in Alzheimer Disease
Authors: Blass John P. , Hanin Israel , Barclay Laurie , Kopp Ursula , Reding Michael J.
Published: April 2015

In a prospective, double‐blind study of 84 unselected persons in a dementia clinic, the red blood cell/plasma choline ratios were found to be significantly higher in 47 subjects with clinically defined Alzheimer disease (DAT) than in 37 non‐DAT, nondepressed subjects (3.54 ± 0.48 versus 2.04 ± 0.34, p < 0.02). The latter group included intellectually intact subjects as well as patients with other dementias who were comparable to the Alzheimer patients in age, sex, and degree of cognitive impairment. The elevated mean ratio reflected the greater proportion of Alzheimer patients with high red blood cell plasma choline ratios. These elevated ratios appeared to be related to both increases in red cell content and decreases in plasma choline. The authors conclude that the results confirm and extend those previously reported in short series of patients and agree with other evidence that Alzheimer disease has systemic manifestations in nonneural cells, which may be useful in further investigations of the disease's cellular pathophysiology.
Xenon Contrast CT‐CBF Measurements in Parkinsonism and Normal Aging
Authors: Tachibana Hisao , Meyer John S. , Kitagawa Yasuhisa , Tanahashi Norio , Kandula Prasab , Rogers Robert L
Published: April 2015

Local cerebral blood flow (LCBF) and local tissue:blood partition, coefficient (LΛ) values were measured during CT scanning while patients with different types of Parkinson's syndrome (N = 14) inhaled a contrast mixture of 35–37 per cent stable xenon gas in oxygen. Single‐compartment analysis fitted to infinity was used to calculate LΛ and LCBF values. Results were compared with results from normal age‐matched volunteers (N = 24). Mean hemispheric (p < 0.05) and subcortical (p < 0.05) gray matter LCBF values were reduced in idiopathic Parkinson's disease (N = 11), compared to values from age‐matched normals. Regionally, LCBF reductions included frontal (p < 0.001), parietal cortex (p < 0.05), caudate (p < 0.05), lentiform nuclei (p < 0.001) and thalamus (p < 0.05) reductions. LΛ values were normal. Unilateral tremor and/or rigidity correlated directly with reduced LCBF in contralateral lentiform (p < 0.01) and caudate (p < 0.01) nuclei. In postencephalitic Parkinsonism (N = 1) LCBF reductions were diffuse, with normal LΛ values. In the akinetic form of Parkinsonism (N = 1) associated with lacunar infarcts, LCBF and LΛ reductions were patchy. In Parkinsonism following carbon monoxide poisoning (N = 1), LCBF values of gray and white matter were diffusely reduced and LΛ values were reduced in both pallidal regions. When dementia was present together with Parkinsonism (N = 3), LCBF reductions were more diffuse and severe. Dopaminergic deficiency correlated directly with reduced LCBF values, reflecting the severity of Parkinsonism. J Am Geriatr Soc 33:413, 1985
Survey of Hypnotic Drug Use in Nursing Homes
Authors: James David S.
Published: April 2015

The prescribing patterns for hypnotic medications were surveyed in 765 patients of three skilled‐nursing facilities and two intermediate‐care facilities. Seven per cent of the patients received a hypnotic routinely; an additional 3 per cent had as‐needed orders for a hypnotic medication. Temazepam, flurazepam, and triazolam were, in descending order, the three most commonly prescribed hypnotics and accounted for 79 per cent of the hypnotic prescriptions. The average duration of use for triazolam, temazepam, and flurazepam was 11 weeks, 24 weeks, and 82 weeks, respectively. Seventy‐six per cent of the flurazepam prescriptions were given seven days a week; 31 per cent of these prescriptions were for 30 mg doses. Medications that were not hypnotics but did have sedative side‐effects were prescribed with bedtime orders for 11 per cent of the patients. The three most commonly prescribed drugs in this class were diphenhydramine, thioridazine, and haloperidol. Possible explanations for the lower frequency of hypnotic use observed in this study as compared to the frequencies reported in the literature are discussed, as are possible hazards of high‐dose and long‐term use of hypnotics.
Treatment Decisions in a Skilled‐nursing Facility: Discordance with Nurses' Preferences
Authors: Wolff Michael L. , Smolen Susan , Ferrara Linda
Published: April 2015

Hospitalization transfers from a skilled‐nursing facility were studied. A hierarchically arranged questionnaire on acute medical deterioration and treatment aggressiveness was used to study the degree of discordance between the transfers actually made and the preferences of nursing home head nurses. According to the nurses, 37 per cent of the patients involved should not have been hospitalized even under the most compelling circumstances; however, 76 per cent of this subgroup had in fact been hospitalized under physician's orders. The nurses would have refrained from instituting any new treatment in 14 per cent of the cases, all of which involved chronic neurological impairments; 36 per cent of this subgroup had nevertheless been hospitalized in the 12 months prior to the study. J Am Geriatr Soc 33:440, 1985
Hyposomatomedinemia in the Nursing Home Patient
Authors: Rudman Daniel , Nagraj Hoskote S. , Mattson Dale E. , Erve Peter R. , Rudman Inge W.
Published: April 2015

Plasma somatomedin C (SmC) concentration was compared in three groups of men: 58 healthy independent men aged 26 to 45 years; 28 independent men aged 52 to 87 years; and 50 male nursing home residents aged 51 to 95 years. Somatomedin C (mean ± SE) was 0.73 ± .04 U/mL, 0.41 ± .03 U/mL, and 0.33 ± .03 U/mL in these three groups, respectively (P < .05 for the differences between all three groups). Somatomedin C less than 0.25 U/mL, a range consistent with severe growth hormone deficiency in children, occurred in 0% of the independent younger men, in 15% of the independent elderly, and in 37% of the nursing home men. Somatomedin C was inversely correlated with age in the independent elderly, but the excess of hyposomatomedinemia in the nursing home men was not explained by age. J Am Geriatr Soc 34:427–430, 1986
Hearing Impairment and Cognitive Decline in Senile Dementia of the Alzheimer's Type
Authors: Uhlmann Richard F. , Larson Eric B. , Koepsell Thomas D.
Published: April 2015

Hearing impairment has been hypothesized as contributing to symptoms of dementia. Data from a longitudinal study were analyzed to determine if auditory status predicted cognitive functional decline in senile dementia of the Alzheimer's type (SDAT). As part of a larger study, 156 consecutive SDAT outpatients had received a comprehensive medical evaluation including baseline screening for hearing impairment with the finger friction test and serial assessment of cognitive function with the Mini‐Mental State examination. Age and cognitive function at entry to the study were greater among individuals with impaired hearing (N = 36) than with normal hearing (N = 120). The demographic profiles of the impaired and normal hearing groups were otherwise similar, as was the prevalence of depression. Intervening mortality rates were nearly identical. Decline in cognitive function one year later, however, was nearly twice as great in the impaired hearing group, a statistically significant difference (P < .05, by one‐tailed t test) even when controlled for age and initial cognitive function. These results, which need to be verified with sophisticated audiometric techniques, suggest that hearing impairment may be a prognostic indicator for subsequent cognitive dysfunction in SDAT. They are consistent with the hypothesized relationship between hearing impairment and dementia in SDAT as well as alternative hypotheses discussed in the text.
Genitourinary Dysfunction in a Geriatric Outpatient Population
Authors: Ouslander Joseph G. , Hepps Kenneth , Raz Shlomo , Su Hong‐Lin
Published: April 2015

Clinical and urodynamic findings in 167 women and 96 men, aged 65 years and older evaluated consecutively during a four‐year period in an outpatient urodynamic laboratory, are presented and compared with findings from other studies of geriatric populations. Seventy‐three percent of the patients (81 % of the women and 60% of the men) presented with symptoms of incontinence, most commonly of the mixed type. Although pathological lesions such as tumors and stones were rare, urodynamic abnormalities were common. Urodynamic evidence of sphincter weakness in women and detrusor motor instability were the most common urodynamic findings among patients who presented with incontinence. Close to 20% of patients who presented without incontinence also had one or more of these findings. Approximately one‐third of patients had multiple urodynamic findings, emphasizing the complexity of the pathophysiology, diagnosis, and treatment of genitourinary dysfunction in many geriatric patients. Despite the long duration of symptoms in most patients, the majority were substantially improved after diagnosis and treatment of the specific genitourinary and urodynamic abnormalities detected. J Am Geriatr Soc 34:507–514, 1986
Single Oral High‐Dose Vitamin D3 Prophylaxis in the Elderly
Authors: Weisman Yosef , Schen Refael J. , Eisenberg Zipora , Amarilio Ninetta , Graff Eran , Edelstein‐Singer Maia , Goldray David , Harell Arie
Published: April 2015

A poor vitamin D status is common in the elderly during the winter months. Because it is possible that hypovitaminosis D may be a cause of senile osteopenia, a simple method of prophylaxis would be useful. The single, oral, high‐dose method was tested in two old‐age homes, and the efficacy of vitamin D3 was compared with that of 25‐hydroxyvitamin D3 (25‐OHD3). The trials showed that 25‐OHD3 caused a higher peak value in the serum 25‐OHD levels in the second week than did vitamin D3. However, follow‐up after four to five months showed that in those patients who received a single, oral dose of 25‐OHD3, the serum 25‐OHD levels had returned to the baseline low values, whereas in those patients who had had oral vitamin D3, the serum 25‐OHD levels still remained significantly raised compared with the baseline values and were within normal limits, It is concluded that the single, oral, high‐dose method using vitamin D3 is a safe and simple method of prophylaxis and could be used easily in large populations of elderly persons. J Am Geriatr Soc 34:515–518, 1986
Nursing Home‐Acquired Pneumonia: A Case‐Control Study
Authors: Marrie Thomas J. , Durant Heather , Kwan Carol
Published: April 2015

To determine if there are any unique features of nursing home‐acquired pneumonia we carried out a case‐control study wherein each patient admitted with nursing home‐acquired pneumonia was age‐ and sex‐matched with a patient with community‐acquired pneumonia. There were 36 men and 38 women in the nursing home group. The mean age of both groups was 74 years. The mortality rate for nursing home‐acquired pneumonia was 40.5%, whereas for community‐acquired pneumonia it was 28% (P = NS). Patients with nursing home‐acquired pneumonia had a significantly higher incidence of dementia and cerebrovascular accidents, and patients with community‐acquired pneumonia were more likely to be smokers and to have chronic obstructive pulmonary disease. Aspiration pneumonia was more common among patients with nursing home‐acquired pneumonia (P < .001), and Hemophilus influenza pneumonia more common among the patients with community‐acquired infection (P < .01). Sputum for culture could be obtained in only 31 and 39% of the patients—contributory to the high rates of pneumonia of unknown etiology 63.5 and 56.1% for the nursing home group and the control subjects, respectively. Patients with nursing home‐acquired pneumonia received cloxacillin and aminogylcosides more frequently than patients with community‐acquired pneumonia (P < .05), and patients with community‐acquired pneumonia received erythromycin more frequently than patients with nursing home‐acquired pneumonia (P < .05). Complications were common during the hospital stay of these patients—the most frequent being congestive heart failure, urinary tract infection, renal failure, and respiratory failure.
Agitated Behaviors in the Elderly: II. Preliminary Results in the Cognitively Deteriorated
Authors: Cohen‐Mansfield Jiska
Published: April 2015

Agitation was studied in 66 nursing home residents from two nursing units for agitated, cognitively deteriorated elderly. The frequency of occurrence of manifestations of various agitated behaviors was documented by nursing home staff using a seven‐point frequency rating scale. Additionally, the factors of age, cognitive level, activities of daily living (ADL) functioning, frequency of waking up at night, and medication for agitation were monitored, and nurses' attributions for agitation in each individual were reported. Results indicated that: 1) agitated behaviors were strongly interrelated; 2) specific nonaggressive behaviors, such as pacing and constant request for attention, occurred most frequently; 3) in this very agitated and cognitively deteriorated group, agitated individuals did not differ from nonagitated persons in age, cognitive level, and waking up at night; 4) agitated individuals received more medication for agitation and had a higher incidence of falls as compared with nonagitated people; and 5) the most frequent medications given for agitation were thioridazine and haloperidol. The study is viewed as a preliminary effort to understand the phenomenon of agitation. Results serve as indicators for future research and demonstrate the widespread implications of research for handling and preventing agitation as well as for policy planning with regard to placement and reimbursement.
Cognitive Performance Correlates With Cerebrovascular Impairments in Multi‐infarct Dementia
Authors: Judd Brian W. , Meyer John S. , Rogers Robert L. , Gandhi Sunil , Tanahashi Norio , Mortel Karl F. , Tawaklna Talat
Published: April 2015

Cerebral blood flow (CBF) was measured by the 133Xe inhalation method in patients with multi‐infarct dementia (MID, N = 26), Alzheimer's dementia (AD, N = 19), and among age‐matched, neurologically normal, healthy volunteers (N = 26). Cognitive performance was assessed in all subjects using the Cognitive Capacity Screening Examination (CCSE). Cerebral vasomotor responses were calculated from differences in values of mean hemispheric gray matter blood flow (ΔCBF) measured during inhalation of 100% oxygen (hyperoxia) compared with CBF measured while breathing room air. Significant correlations were found between CCSE performance and vasomotor responsiveness in patients with MID (P < .01), but not in patients with AD or in neurologically normal volunteers. Loss of vasomotor responsiveness is an indicator of cerebrovascular disease with rigidity and/or loss of reactivity of cerebral vessels, which impairs cerebrovascular responses to situational demands and predisposes to cerebral ischemia. Loss of cerebral vasomotor responsiveness among MID patients, which is a biologic marker of cerebrovascular disease, provides confirmatory evidence of the vascular etiology of MID and assists in separating MID from AD patients.
Breast Cancer in the Elderly
Authors: Allen Cathy , Cox Edwin B. , Manton Kenneth G. , Cohen Harvey J.
Published: April 2015

To evaluate age‐related differences in the current patterns of presentation and clinical management of breast cancer patients, the authors reviewed 1795 patients referred to a university hospital for their initial treatment. No age‐related differences were found with respect to laterality and anatomic site. Age‐related differences were seen with respect to histology, with mucinous (colloid) carcinoma being relatively more common with increasing age and medullary and inflammatory carcinoma being more common among young patients. Patients over age 55 presented with more advanced extent of disease, but the proportion did not further increase above age 65. Patients age 75 and older were nearly twice as likely to have surgery as their sole treatment as patients under age 45. The difference in treatment was specifically associated with the differential use of adjuvant chemotherapy between age groups. Sixty percent of patients under 45 with regional node involvement received adjuvant chemotherapy compared with only 27% of those 65 and older. Despite their similar characteristics in regard to laterality, anatomic site, and histology, elderly patients are less frequently given adjuvant chemotherapy in stage II breast cancer.
Absolute Peripheral Blood Lymphocyte Count and Subsequent Mortality of Elderly Men
Authors: Bender Bradley S. , Nagel James E. , Adler William H. , Andres Reubin
Published: April 2015

In this 16‐year longitudinal study of 105 healthy elderly men, we analyzed one aspect of immunosenescence—a decline in the absolute number of peripheral blood lymphocytes—with particular reference to its relationship with subsequent mortality. It was found that there was a significantly (P < .01) lower absolute lumphocyte count (1432 ± 55/mm3; mean ± SEM) within three years of death when compared with five years (1719 ± 89/mm3) or 10 years (1715 ± 98/mm3) before death. There was no relationship between this decrease in lymphocytes and age at death, smoking status, or prior cardiac illness. Previous cross‐sectional studies have yielded conflicting data on age‐related decreases in lymphocytes which may have been the result of an unrecognized selection process that either eliminated or included subjects who were close to death.
Clinical Digoxin Toxicity in the Aged in Association With Co‐Administered Verapamil
Authors: Gordon Michael , Goldenberg Leslie M. C.
Published: April 2015

Digoxin toxicity occurs more commonly in aged than younger individuals. Cardioactive drugs such as quinidine effect digoxin pharmacokinetics so as to increase the potential for digoxin toxicity. The calcium‐channel antagonists have become extensively used for cardiac disorders and are often co‐administered with digoxin. Despite documented calcium‐channel antagonist interactions with digoxin, clinically significant digoxin toxicity associated with their concurrent use is apparently unusual. Two elderly patients receiving digoxin and verapamil simultaneously are presented to demonstrate the clinical importance and potential danger of the concomitant use of these drugs.
Management of Isolated Systolic Hypertension in the Elderly
Authors: Gifford Ray W.
Published: April 2015

Now that the benefits of treating diastolic hypertension in the elderly have been convincingly proved, attention is turning to the need for, and the choice of, treatment of isolated systolic hypertension in this age group. The hemodynamic mechanism differs in the elderly, whose isolated systolic hypertension is likely to be accompanied by reduced cardiac output, high peripheral resistance, and reduced plasma volume, whereas young people with similar blood pressure may have high cardiac output, normal peripheral resistance, and normal plasma volume. Increased risk of cardiovascular morbidity and mortality and the importance of reducing cardiac workload in older persons, are significant factors in the need for reduction of systolic pressure. After a good history and physical examination, and a careful check to ascertain that the elevated pressure is measured accurately, elderly patients can begin stepped‐care therapy with a diuretic such as hydrochlorothiazide or chlorthalidone. The considerable dangers of a sudden drop in blood pressure can be avoided by giving small initial doses. Methyldopa or clonidine is recommended for step two; the third step can be hydralazine. Side effects, especially in the elderly, should be monitored carefully.
Gallbladder Volvulus in the Elderly
Authors: McHenry Christopher R. , Byrne Mitchel P.
Published: April 2015

Volvulus of the gallbladder is an extremely rare condition presenting often in elderly patients commonly mimicking acute cholecystitis. Two cases of gallbladder volvulus in two octogenarian patients are presented from our institution. Clinical presentation is reviewed and some characteristic clinical and radiographic findings are described. The etiology of this rare entity is discussed with particular emphasis on visceroptosis, a common finding in elderly patients. The importance of early recognition and rapid treatment of this potentially fatal disease is emphasized. It is possible with increasing longevity, with its accompanying tendency to visceroptosis, that this entity may occur more frequently in the future. Its recognition and proper treatment is essential to good results in this elderly group of patients.
Geriatrics
Authors: Rosenthal Mark
Published: April 2015

This is the author's third revision of a geriatrics bibliography. Approximately two thirds of the old references have been replaced by more current or more detailed articles. The bibliography has been expanded to include several additional topics and over 250 new references from 135 different journals.

Because the literature pertinent to geriatrics has continued to grow ever more rapidly, it has been necessary to omit many informative articles from the bibliography. Preference is given to recent publications; almost all of the references date from the past four years. Some articles were selected to highlight current controversies or changes in viewpoint. An occasional unrefereed article is cited to amplify geriatric aspects of common diseases.

Most of the references deal specifically with an elderly patient population, though few use a multidisciplinary approach. Studies of the elderly are confounded by the concomitants of aging frequent but not universal in our society: inactivity, obesity, malnutrition, and psychosocial trauma. The articles cited concern primarily medical ailments of the elderly but legal, ethical, and sociologic topics are also covered.

The references are divided into categories. The first (I) set deals with some possible causes of aging, the second (II) with physiologic decline accompanying aging, the third (III) with the atypical and nonspecific characteristics of illness among geriatric patients, the fourth (IV) with the elderly and society, and the fifth (V) with care options. The remainder of the references are cited by pertinent medical specialty. Within each category, references are divided by disease process. Articles are further subgrouped by aspects of those diseases such as evaluation or therapy.
Incidence of Physical Restraints on Acute General Medical Wards
Authors: Frengley J. Dermot , Mion Lorraine C.
Published: April 2015

On four acute medical wards 1292 patients were observed over 15 weeks to determine how frequently physical restraints were used. Patients were divided into age groups of less than 40 years, 40 to 55 years, 56 to 69 years, and 70 years and older. Ninety‐five patients were found to be restrained giving an overall incidence of 7.4%. As expected, patients 70 years of age and older were restrained more frequently (20.3%) than younger patients, with the lowest incidence (2.9%) occurring in those 40 to 55 years of age. In each age group the patients who were restrained had a length of stay more than twice as long as their unrestrained counterparts. Twelve percent of the restrained patients died, which was nearly one‐half of all the patients who died during the period of the study. The findings suggest a probable relationship between the severity of an illness and the use of physical restraints.
The Bartling Case
Authors: Lo Bernard
Published: April 2015

The recent legal decision in the Bartling case affirmed that competent patients may refuse life‐sustaining treatment, even if they are not terminal or comatose and even if physicians object because of ethics or conscience. However, clinicians may be concerned that patient refusal of treatment is not truly informed. Physicians have an obligation to benefit patients as well as to respect patients' wishes. They may fulfill both obligations by determining whether further medical treatment is indicated, identifying reversible conditions that may impair patient decision making, and checking that the patient's decision is informed.
Treatment of Dementia in a Medical Day Care Program
Authors: Chodosh H. Louis , Zeffert Barbara , Muro Elisabeth Scotti
Published: April 2015

An analysis was completed of 34 patients with dementia who attended a mixed medical day care program over a five‐year period. The parameters reviewed included age, home situation, diagnosis, incidence of co‐existent medical disorders, management by the social worker, nurses and neuropsychiatrist, the extent of social and program participation, length of stay, and disposition. There was a high incidence of medical problems which were managed effectively because of close nursing observation, availability of ancillary services, specialty clinics, and frequent communication with the community physicians. The social worker assisted families with the management of long‐term planning for the dementia patients and the entire social‐nursing‐recreational therapy team devised programs which encouraged the patients to function at an optimum level. Neuropsychiatrie management, including drug therapy, was an integral part of the program.
Evaluation of a Novel Medication Aid, the Calendar Blister‐Pak, and its Effect on Drug Compliance in a Geriatric Outpatient Clinic
Authors: Wong Betty Sau Mei , Norman Dean C.
Published: April 2015

A prospective, controlled, crossover study on drug compliance was initiated in 22 elderly patients from a geriatric clinic. Half of the patients received their pills from a commercially prepared calendar mealtime blister‐pak; the remaining patients received their medication from standard pill bottles. At the end of three months the two groups were crossed over. Pill count and issuance of a new drug supply were done monthly to assess compliance. It was found that the average noncompliance index was significantly decreased (9.17 to 2.04) with the blister‐pak packaging system. The relationship of age, Folstein mini‐mental status, over compliance, frequency of dosing interval, and living situation were also explored.
Use of Assessment Instruments in Clinical Settings
Authors: Applegate William B.
Published: April 2015

In recent years, increased emphasis has been placed in the field of geriatric medicine on the need for multidimensional assessment of elderly patients. There is an increasing tendency to use standardized structured assessment instruments or questionnaires in this process. Frequently, the exact question or set of questions to be answered by the instrument has not been carefully analyzed. Although comprehensive structured multidimensional instruments allow the collection of large amounts of data in multiple domains (physical, social, psychologic, economic), these instruments may require excess data collection and may not be reliable in clinical settings. Clinicians considering using a variety of assessment instruments should carefully consider their goals for data collection and carefully review the validity, reliability, and population sampled for any assessment instruments under consideration. Also, the clinical setting in which the instrument is to be used can have a negative impact on either instrument validity or reliability.
Prevalence of Thyroid Disease and Abnormal Thyroid Tests in Older Hospitalized and Ambulatory Persons
Authors: Livingston Edward H. , Hershman Jerome M. , Sawin Clark T. , Yoshikawa Thomas T.
Published: April 2015

To determine the utility of laboratory tests for diagnosing thyroid disease in the hospitalized elderly, we measured serum thyroid‐stimulating hormone (TSH), thyroxine (T4), free thyroxine index (FT4I), triiodothyronine (T3), and free triiodothyronine index (FT3I) in 125 geriatric inpatients, mostly men, and compared the results to those in elderly ambulatory patients. Hypothyroidism (TSH > 10 μU/mL with a low T4 and FT4I or clinical findings) was present in 7.8% (nine of 116) of male inpatients compared to only 0.7% of male ambulatory controls (P < 0.01). Only a few women were studied but 17% (two of 12) were hypothyroid compared to 2.4% of ambulatory elderly women. Three of the hypothyroid inpatients had no clinical clue to their hypothyroidism. Further, decreased thyroid reserve or subclinical hypothyroidism (TSH > 10 μU/mL with a normal T4 and FT4I and no overt clinical findings), a condition which may lead to overt hypothyroidism, was more common in male inpatients (4.3%) than in male ambulatory controls (1.8% [P < 0.01]). Thus, a clearly elevated serum TSH (> 10 μU/mL) was more common in inpatient (12.1%) than in ambulatory (2.4%) elderly men (P < 0.01).

Four inpatients and nine ambulatory controls had an elevated T4 and FT4I, but in only one (0.8%) inpatient and one (0.6%) control was a final diagnosis of hyperthyroidism made; the others had no clinical findings and a normal or low T3 and FT3I.

A low T3 and FT3I or T4 and FT4I occurred with equal prevalence in inpatient (19%) as in ambulatory older men (14.9%); three of 12 women inpatients also had a low T3 and FT3I. This finding did not aid in diagnosing thyroid dysfunction.

Because of the high prevalence of thyroid disease, predominantly hypothyroidism, in the inpatients (9.4%, or 14.1% if decreased thyroid reserve is included) and the difficulty in detecting thyroid disease on clinical grounds (27% of inpatients with thyroid disease had no specific clinical manifestation), we recommend that geriatric patients, including men, be screened for thyroid dysfunction by measurements of serum TSH and T4 (or FT4I) upon hospital admission.