bluuebunny/crossref_metadata_2025 huggingface dataset:
Nosocomial Urinary‐Tract Infections in a Skilled Nursing Facility†
Authors: Sherman Fredrick T. , Tucci Victor , Libow Leslie S. , Isenberg Henry D.
Published: April 2015

Fifty‐five documented infections reported from an admission unit of a large skilled nursing facility (SNF) during a five‐month period were analyzed. Of these, 45 (82 percent) were urinary‐tract infections (UTIs), chiefly asymptomatic bacteriuria. Sixty‐three percent of the UTIs were acquired in the SNF, and the remainder were acquired during the preceding stay in a general hospital. Statistically, Proteus species infections were more common among the SNF‐acquired UTIs, whereas Pseudomonas aeruginosa infections were the most common among the hospital‐acquired UTIs. The following recommendations are made: 1) for previously hospitalized elderly patients in whom urinary‐tract sepsis develops soon after admission to an SNF, treatment should start with an antibiotic active against Pseudomonas aeruginosa while the results of cultures are pending; 2) symptomatic lower urinary‐tract infections caused by SNF‐acquired Proteus species should be treated with nalidixic acid or trimethoprim**‐sulfamethoxazole; 3) the term “nosocomial infection” should be broadened to include infections acquired in long‐term care institutions; and 4) infection surveillance should be started in selected long‐term care institutions for the elderly as part of an expanded National Nosocomial Infections Survey.
Urinary Catecholamine Response to Glucagon in Young and Elderly Patients with Essential Hypertension†
Authors: Mandai Takashi , Ogihara Toshio , Hata Takeshi , Okada Yoshiaki , Ogasahara Saburo , Mikami Hiroshi , Nakamaru Mitsuaki , Kumahara Yuichi
Published: April 2015

The role of the sympathetic nervous system (SNS) in essential hypertension was evaluated by examining the response of urinary catecholamines to the intramuscular injection of glucagon in both young and elderly normal subjects (total 16) and in both young and elderly patients with essential hypertension (total 16). Urine was collected for 2 hours before glucagon injection and for 2 and 4 hours after injection, for determination of adrenaline and noradrenaline. The increments of urinary adrenaline and noradrenaline after glucagon injection were significantly higher in young hypertensive than in young normotensive subjects or in normotensive and hypertensive elderly subjects. The observation that the reactivity of the SNS is increased in young patients with essential hypertension lends support to the hypothesis that the SNS is more important in the maintenance of hypertension in the young than in the elderly.
Prevention of Falls in the Elderly
Authors: Overstall P. W.
Published: April 2015

To prevent falls effectively, one must first understand the underlying reasons. Although environmental factors are sometimes to blame, the fundamental cause is a decline in postural control which is partly age‐related and partly due to pathologic changes in the central nervous system. Dizziness is a common complaint among those who fall, and it is often caused by a central or peripheral vestibular disorder. Many patients who complain of dizziness do not have true vertigo but are expressing a fear of falling. Balance exercises can improve postural control and confidence in these patients. Falls are not inevitable in old age and may be prevented by maintenance of health, mobility and confidence, the avoidance of certain drugs, identification of specific problems such as cardiac arrhythmias or postural hypotension, and attention to environmental hazards.
Measured versus Estimated Creatinine Clearance in the Elderly as an Index of Renal Function
Authors: Gral Thomas , Young Marilyn
Published: April 2015

Measured endogenous creatinine clearance (requiring 24‐hour urine collection) was compared to estimated (calculated) creatinine clearance obtained by 2 formulas and a nomogram (without urine collection), in 26 elderly nursing home residents. All were clinically stable and had adequate intakes of food and fluid. Of the 26 subjects, 23 had a “normal” value for serum creatinine concentration (0.7–1.5 mg/dl) with a mean of 1.1 mg/dl. Measured creatinine clearance (Ccr) was reduced in all patients despite a “normal” serum creatinine level. The mean Ccr was 47.2 ml/min, with values as low as 21.6 ml/min. Measured Ccr findings compared well with estimated (calculated) findings, the correlation coefficients being highly significant in all instances. If it is difficult or impossible to collect a 24‐hour urine specimen, a fairly accurate assessment of renal function may be obtained by using a simple formula (or nomogram) for estimating creatinine clearance on the basis of the patient's age, weight (height) and serum creatinine level.
Evaluating Loss of Consciousness in the Elderly
Authors: Scherokman Barbara , Massey E. Wayne
Published: April 2015

In the case of an elderly patient with transient loss of consciousness, the chief differential diagnosis is syncope versus seizure. The most helpful diagnostic aid is a thorough history obtained from both the patient and an observer. The tentative diagnosis based on the history can be confirmed by the findings on physical examination and by such secondary studies as an electroencephalogram and a series of cardiac tests.
Relationship of Depression to Physical and Psychologic Complaints in the Widowed Elderly
Authors: Elkowitz Edward B. , Virginia Arcilio T.
Published: April 2015

Coping with depression has always been a central theme in the life of the elderly, and many efforts have been made to develop a valid form of assessment. This article shows that an analysis of compliance may usefully supplement the usual instruments for measuring depression. The study group consisted of 10 widows and 8 widowers (age range, 69–74 years). They were tested by the Zung Depression Scale, particularly for physical and psychologic complaints. The pattern and correlates of these complaints are discussed in relation to depression and sex. The data indicate a relationship between compliance and the severity of depression, and also between sex and the expression of distress feelings.
Idiopathic Hypertrophic Subaortic Stenosis and Aortic Regurgitation in an 84‐Year‐Old Man
Authors: Habibzadeh M. A.
Published: April 2015

During the ninth decade of life, idiopathic hypertrophic subaortic stenosis (IHSS), particularly when associated with other cardiac disorders, presents a confusing clinical problem. Unless the physician has a high index of suspicion, the diagnosis is easily overlooked, and consequently inappropriate management of the patient may lead to serious complications. One such case in an 84‐year‐old man is described. Administration of certain drugs may only intensify symptoms. Echocardiography is invaluable for diagnosis. Pertinent clinical features of IHSS in the eighth and ninth age decades are outlined.
Deep Posterior Tibial Compartmental Syndrome after Accidental Hypothermia in an Elderly Hypothyroid Patient
Authors: Coni N. K.
Published: April 2015

Compartmental syndromes are uncommon, but particularly the deep posterior tibial compartmental syndrome, which is usually associated with trauma. It has not previously been recorded as a complication of hypothermic or hypothyroid coma. This case of successful surgical therapy in a 75‐year‐old woman is reported in the hope that similar occurrences in the future may be recognized in time for curative surgery or at least for palliative surgery which can offer recovery of useful function.
Conjoint Therapy of Psychiatric Problems in the Elderly
Authors: LaWall John
Published: April 2015

In treating elderly psychiatric patients, interviewing spouses together may be the most useful setting. Data gathering, reality testing and reality orientation can all be enhanced by the “well” spouse. The physician also can assess the value of the “well” spouse as a co‐therapist. Two case reports illustrate this method of aiding treatment.
Young‐Old versus Old‐Old and the Use of Health Services. Does the Difference Make a Difference?*
Authors: Snider Earle L.
Published: April 2015

The literature indicates the necessity for different levels of health service for various age cohorts among the elderly. The present study concerns the relationship between age cohorts and the use of community‐based ancillary health services in comparison with other enabling, predisposing, and health status factors. In a probability sample of Western Canadian older persons, three enabling variables were found to be most closely associated with the use of such health service, i.e., knowledge of health services, education, and monthly family income. Age differences among the elderly, a predisposing variable, were unrelated. Implications for the delivery of health services are discussed.
Effect of Age on Active and Inactive Plasma Renin in Normal Subjects and in Patients with Essential Hypertension*
Authors: Nakamaru Mitsuaki , Ogihara Toshio , Higaki Jitsuo , Hata Takeshi , Maruyama Anna , Mikami Hiroshi , Naka Toru , Iwanaga Keiichi , Kumahara Yuichi , Murakami Kazuo
Published: April 2015

The effect of age on the levels of active and trypsin‐activatable inactive plasma renin was examined in 41 normal subjects and 54 patients with essential hypertension, during recumbency and after stimulation with furosemide and ambulation. Active renin levels in supine subjects and patients decreased with age. Inactive renin levels did not change with age in normal subjects, whereas in hypertensive patients they decreased with age. Following stimulation with furosemide and ambulation, the levels of active renin increased but the responsiveness to stimulus decreased with age in both groups. In contrast, inactive renin levels slightly increased after furosemide administration and ambulation, resulting in an increased proportion of active to total renin. These data show that an acute stimulation with furosemide and ambulation affects mainly the active form of plasma renin, and the effect of age on inactive plasma renin in normal subjects may be different from that in patients with essential hypertension.
Heart Weights Among Octogenarians
Authors: HOWELL TREVOR H.
Published: April 2015

The weights of hearts among 110 octogenarians were studied. At autopsy they ranged from 174 to 785 gm, which is more than the customary norm for adults. In only 15 subjects were the hearts considered completely normal. Other hearts showed hypertrophy, friable muscle, fatty infiltration, brown atrophy, a flabby myocardium, valvular changes, and atheroma or calcification of the coronary arteries. The frequency of these changes and their relationship to heart weight are discussed. A previous study of heart weights among 39 nonagenarians had shown weights ranging from 159 to 539 gm — somewhat less than those among the octogenarians. Heavy heart weights are common in these two age groups.
The Masculine Gender Role and Its Implications for the Life Expectancy of Older Men*
Authors: SOLOMON KENNETH
Published: April 2015

The lifespan of men is shorter than that of women. This study is an effort to identify some causal factors. Six dimensions of the masculine gender role are examined in relation to certain stress‐related disorders more prevalent among older men than among older women. These dimensions are “No Sissy Stuff”; “The Big Wheel”; “The Sturdy Oak”; “Give ‘Em Hell”; homophobia; and sexual dysfunctioning. Specific problems of retirement are also discussed. Only in recent years have the roles of men been studied more closely. The results may offer positive implications for the lifespan of men.
Social Support and Alternatives to Institutionalization for the At‐Risk Elderly
Authors: LINDSEY ADA M. , HUGHES ELIZABETH M.
Published: April 2015

Selected findings are reported from a follow‐up study conducted to determine what happened to persons aged 65 or older who were referred for evaluation to an urban Geriatric Evaluation Service (GES) but who were not approved by the GES for admission to a mental hospital. Reasons given for the referral included both physical and behavioral problems. The alternatives to institutionalization were based upon the nature of the available social support system, and the functional health status. The family provided most of the care for its aged ill, and the adult children provided most of the social support. In the absence of support by adult children, other relatives gave the necessary care, which included a wide range of services such as personal care, housekeeping, cooking, running errands, transporting, and the important service of just being present or available. Community services were used infrequently. The majority of the subjects were in the “poor health” category and required supervision or care for impaired mobility, one or more physical health problems, and sometimes for mental confusion or disorientation
Nosocomial Pneumococcal Pneumonia in the Elderly
Authors: BERK S. L. , GALLEMORE G. M. , SMITH J. K.
Published: April 2015

Among 35 elderly patients with transtracheal aspirate (TTA)‐documented nosocomial pneumonia, 7 (20 percent) had Streptococcus pneumoniae infection. Clinical and epidemiologic data are reported on these 7 patients and on 2 others with nosocomial pneumococcal pneumonia documented by bacteremia. Malignancy and chronic obstructive pulmonary disease were the most common predisposing illnesses. Four of the 9 patients had previously received antibiotic therapy. Gram‐negative aerobic pneumonia was found before (2 cases), concomitant with (3 cases), and after (2 cases) the pneumococcal infection in these patients.
Management of Incarcerated Vaginal Pessaries
Authors: POMA PEDRO A.
Published: April 2015

Uterine procidentia is relatively common among white multiparous women. The incidence increases with age in association with other predisposing factors. Conservative management of uterine prolapse is rare today, perhaps due to definitive results with surgical therapy and the high incidence of earlier hysterectomy. Still, physicians should become familiar with pessary use and its complications. Three conservatively managed cases of pessary incarceration are reported. Applications of estrogen cream improved the condition of the vagina, permitting removal of the incarcerated pessary a few days later. Careful instruction of patients and relatives about follow‐up care can prevent such complications.
Chlorpropamide‐Induced Syndrome of Inappropriate Antidiuretic Hormone Secretion
Authors: TANAY A. , FIREMANN Z. , YUST I. , ABRAMOV A. L.
Published: April 2015

The Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is a rare but serious complication of chlorpropamide therapy. In 2 elderly women who had diabetes mellitus, the SIADH developed two months after the chlorpropamide dosage had been increased to 500 mg daily. The syndrome disappeared after withdrawal of the drug. In one of these patients, re‐administration of chlorpropamide resulted in recurrence of the SIADH. A review of the current literature disclosed certain common denominators, i.e., most of the patients are elderly women whose dosage of chlorpropamide was increased shortly before the development of the SIADH.
Functional Assessment of Elderly Subjects in Four Service Settings*
Authors: PFEIFFER ERIC , JOHNSON THOMAS M. , CHIOFOLO R. C.
Published: April 2015

ABSTRACT: Rapid, reliable and valid assessment of the functional status of elderly persons is a prerequisite for the efficient provision of appropriate types of services. The Functional Assessment Inventory, a 30‐minute, multidimensional functional assessment questionnaire, is an abbreviated modification of the OARS Multidimensional Functional Assessment Questionnaire. It was administered by interviewers to a stratified sample of 244 elderly persons in a rural county of Florida, in four service settings. These four sites were: nursing homes (63 subjects), adult congregate living facilities (ACLF) (62 subjects), adult day care programs (60 subjects), and senior centers (59 subjects). Patterns of functional impairment for each setting were identified. Nursing home patients showed impairment in all dimensions (physical, mental, economic, social, and activities of daily living) with mental and ADL impairments predominating. ACLF subjects showed social, mental and ADL impairments. Subjects in adult day care and senior centers were less generally impaired on all dimensions, with physical, mental and ADL impairments predominating in the day care subjects, and social impairments predominating in the senior center subjects. The respondent refusal rate was less than 10 percent. The findings suggest potential for the widespread use of the new shorter Functional Assessment Inventory for determining the type, level, and appropriateness of services for the elderly.
Auditory Acuity and Performance on the Mental Status Questionnaire in the Elderly
Authors: OHTA Dr. RUSSELL J. , CARLIN MARGARET F. , HARMON BILLYE M.
Published: April 2015

ABSTRACT: The relationship between auditory acuity and performance on the Mental Status Questionnaire (MSQ, Kahn et al) was investigated in 27 residents of two skilled nursing facilities. Statistically significant correlations between auditory acuity and MSQ total scores were obtained at 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, and 6000 Hz, but not at 8000 Hz. The correlations between auditory acuity and individual item scores, however, were statistically significant for only those items for which nursing home personnel believed the opportunity existed for residents to hear the answers. These findings are interpreted as providing strong support for a causal relationship between sensory acuity and test performance, indicating that the cognitive capabilities of elderly persons can be underestimated because of their reduced sensory acuity.
Senile Dementia: Combined Pharmacologic and Psychologic Treatment
Authors: YESAVAGE JEROME A. , WESTPHAL JAMES , RUSH LEONARD
Published: April 2015

ABSTRACT: Either supportive counseling (SC) or cognitive training (CT) was used in an attempt to enhance the efficiency of a standard pharmacologic treatment for dementia, viz, dihydroergotoxine mesylate (DEM, Hydergine). DEM was administered orally to 21 moderately demented subjects, in a dosage of 1 mg three times daily; and SC or CT was conducted for one hour every two weeks for a total of 12 weeks. The CT was designed to enhance memory and other intellectual functions by the teaching of organizational schemes and mnemonic devices. Outcome measurements included the Sandoz Clinical Assessment‐Geriatric (SCAG), a behavioral rating scale measuring selected symptoms and signs of dementia; the Hamilton Rating Scale for Depression (HRSD); and the Buschke Selective Reminding Scale (BSRT), a psychometric test of memory and learning. The DEM + CT group of patients improved more than did the DEM + SC group for the measures of memory and learning (BSRT). However, no differences between groups were noted for the HRSD or SCAG behavioral measures.
Gastric Emptying Rate in the Elderly: Implications for Drug Therapy
Authors: EVANS MARK A. , TRIGGS EDWARD J. , CHEUNG MATTHIAS , BROE GERALD A. , CREASEY HELEN
Published: April 2015

ABSTRACT: The effect of the aging process on gastric emptying was studied in 11 elderly subjects (mean age, 77) and in 7 young healthy volunteers (mean age, 26). Gastric emptying rates were assessed by a modified sequential scintiscanning technique after administration of the nonabsorbable chelated radiopharmaceutical 99mTc‐DTPA. The rate of emptying, expressed as half‐time (T1/2e) in minutes, was significantly longer (p < 0.001) in the elderly subjects (mean apparent T1/2e = 123.23 min) compared to the young healthy volunteers (mean apparent T1/2e = 49.69 min). Clinical implications of these findings are discussed, particularly with respect to the rate and extent of drug absorption in elderly persons.
Comparison of Silver Sulfadiazine, Povidone‐Iodine and Physiologic Saline in the Treatment of Chronic Pressure Ulcers
Authors: KUCAN JOHN O. , ROBSON MARTIN C. , HEGGERS JOHN P. , KO FRANCIS
Published: April 2015

ABSTRACT: The presence of bacteria and local infection is an important factor in the local management of chronic pressure ulcers. For successful closure of the ulcer, the bacterial count should be 105 or less per gram of tissue in the granulating wound. In a prospective randomized study of 45 (eventually 40) hospitalized patients, silver sulfadiazine (Silvadene) cream and povidone‐iodine (Betadine) solution were compared to physiologic saline for effectiveness in preparing pressure ulcers for closure. Quantitative bacteriologic techniques on tissue biopsy specimens were used for objective evaluation. In 100 percent of the ulcers treated with silver sulfadiazine cream (15 patients) the bacterial counts were reduced to 105 or less per gram of tissue within the three‐week test period, compared to 78.6 percent in those treated with saline (14 patients) and 63.6 percent in those treated with povidone‐iodine solution (11 patients). Moreover, the ulcers treated with silver sulfadiazine cream responded more rapidly, with one‐third showing bacterial levels of <105 within three days, and half within a week.
Exercise and Skeletal Health
Authors: ALOIA JOHN F.
Published: April 2015

Involutional osteopenia contributes to older persons' susceptibility to fractures of the hip, spine and wrist. Experimental evidence is reviewed that supports the hypothesis that involutional bone loss can be prevented by physical exercise. Weightlessness and immobilization result in accelerated bone loss. In cross‐sectional studies measuring total body potassium (TBK), both muscle mass and bone mass in normal humans have remained strikingly constant. The usual decrease in total body calcium (TBCa) and TBK with increasing age was not observed in a cross‐sectional study of marathon runners. Localized hypertrophy of bone and muscle has been reported for a variety of occupations and sports. Two prospective studies have demonstrated an increment in bone mass after a program of physical exercise. It would seem that certain involutional changes in body composition (loss of TBCa and TBK) can be prevented by increased physical activity, but the effectiveness of specific types and durations of exercise should be investigated.
Screening for Hypertension in an Elderly Population: Report from the Dunedin Program
Authors: HALE WILLIAM E. , MARKS RONALD G. , STEWART RONALD B.
Published: April 2015

Hypertension detection and follow‐up programs have recently received increased attention. The authors studied the effect of screening for hypertension in a geriatric screening program for a large ambulatory elderly population in Dunedin, Florida, over a three‐year period. Of the 4,247 participants initially screened, 39 percent had some form of hypertension, and 15.6 percent of these had not received any form of treatment. At the time of the first year follow‐up, the proportion of participants with treated, controlled hypertension had increased from 14.7 to 21 percent. These data lend support to the value of hypertension screening among persons over 65 years of age.
First‐Year Medical Students and the Aging Patient: A Curricular Model*
Authors: JARVIK LISSY F. , ROSS CLAIRE , KLESSIG JILL , HOFF PAMELA
Published: April 2015

First‐year medical students at UCLA are introduced to the special health problems of the elderly by a process in which they interview symptomatic volunteers at both extended care and ambulatory care facilities. In addition, they interview healthy elderly volunteers to gain information on gerontology and lifespan development, with supplementation from selected readings, films, lectures and panels. This curricular model seems effective in reducing prejudice about the aged and in training future physicians to render humane competent care in the field of geriatrics.
Infected Aortic Aneurysm
Authors: WACHTEL TOM J. , PADIYAR NIRUPAMA
Published: April 2015

ABSTRACT: Aortic aneurysms may become infected. This unusual complication carries a highly unfavorable prognosis. In any patient with sepsis and a known aneurysm, spread of the sepsis to the aneurysm should be suspected if no other source of infection can be found. A case report is presented, together with a brief review of the literature.
The Role of Vaginal Hysterectomy in the Aged Woman
Authors: Ellenbogen Adrian , Agranat Avi , Grunstein Stephen
Published: April 2015

The results of vaginal hysterectomy in 85 women over the age of 65 were reviewed. All the patients' complaints were attributable to uterine prolapse but the frequency of occurrence was not proportional to the given patient's degree of disability. Spinal anesthesia was used the most frequently, as it is usually not contraindicated in the elderly. Certain postoperative complications were encountered, but these did not cause prolongation of the hospital stay. No postoperative deaths occurred. Most of the patients showed complete improvement in terms of personal activity. It is concluded tht vaginal hysterectomy for uterine prolapse is a safe and beneficial operation in the elderly and is preferable to the more limited procedures employed years earlier.
Changes in Endocrine Activities Relative to Obesity in Patients with Essential Hypertension*
Authors: Hiramatsu Kunihide , Yamada Takashi , Ichikawa Kazuo , Izumiyama Tomio , Nagata Hajime
Published: April 2015

The possible role of obesity in the development of hypertension was investigated in two study groups. In a population study of 961 subjects, 739 were found to be normotensive and 222 hypertensive. The prevalence of hypertension was 18.7 percent in the nonobese, and 33.2 percent in the obese subjects. Systolic and diastolic blood pressures increased progressively with the increase of relative body weight in both normotensive and hypertensive subjects. In addition, an endocrinologic study was made of 97 patients with essential hypertension; in 82, plasma renin activity (PRA) was inversely correlated with the increase of relative body weight but not with urinary Na excretion. Despite this decrease of PRA, the level of serum aldosterone was not influenced by relative body weight. Thus, the aldosterone/PRA ratio increased progressively with the increase of relative body weight. Thiazide therapy normalized this inappropriately high ratio, and reduced body weight and blood pressure. Restriction of dietary calories and salt intake had a similar effect. With a high‐salt intake in an obese subject, the aldosterone/PRA ratio is unduly increased. Apparently aldosterone contributes to the additional retention of sodium and water and thereby promotes hypertension in the presence of an expanded fluid volume.
Evaluation of the Systolic Murmur in the Elderly
Authors: DUTHIE E. H. , GAMBERT S. R. , TRESCH D.
Published: April 2015

ABSTRACT: A common clinical entity in the elderly population is the systolic murmur detected during cardiac auscultation. Although it can occur in patients of any age group, the approach to diagnosis differs in the elderly. Two cases are presented which illustrate different pathologic processes that can result in the development of a systolic murmur. The prevalence of this entity in the elderly is highlighted, and a strategy for diagnosis is outlined.
Team Approach to the Problem‐oriented Record in a Long‐term Care Facility
Authors: BEATTIE B. LYNN , CRAWSHAW M. LYNNE
Published: April 2015

At the Extended Care Unit of the Health Sciences Centre Hospital at the University of British Columbia, team participation in the care of 300 elderly patients includes the team's ability to facilitate use of the problem‐oriented record (POR). The key to making the POR a functional communication tool was the development of a useful Problem List. In establishing this system, many difficulties arose. It was imperative to recognize that many staff members had not been trained in problem‐solving techniques, and that they had varying degrees of knowledge about the data base. Active physician involvement was mandatory. Employment of a half‐time POR Coordinator working with a supporting interdisciplinary POR Committee was needed to make the system work. Guidelines for defining problems were developed, and Problem Lists gradually acquired significance for the entire health care team. Examples are included. Concurrent continuing education was started in pathophysiology, problem‐solving, and use of the POR.
Effect of Age on Plasma Glucose and Insulin Responses to a Test Mixed Meal
Authors: MANEATIS T. , CONDIE R. , REAVEN G.
Published: April 2015

Plasma glucose and insulin responses to an oral dextrose tolerance test and to a mixed‐meal test were determined in fully ambulatory residents of a retirement community. The study population consisted of 127 women and 79 men, whose ages ranged from 47 to 90 years. Progressive hyperglycemia and hyperinsulinemia with age could be demonstrated in the women. These changes were observed with either type of tolerance test and could not be attributed to age‐related differences in measurements of body mass index or estimates of physical activity. In contrast, no significant changes with age in either glucose or insulin responses were noted in men. The ability to document increases in the plasma glucose and insulin responses to a mixed meal suggests that aging, at least in women, is associated with day‐long elevations of both plasma glucose and insulin concentrations. The possible relationship of these metabolic changes to the development of atherosclerosis merits further consideration.
Injury in Late Life
Authors: HOGUE CAROL C.
Published: April 2015

Epidemiologic studies show that injury is a nonrandom event of considerable consequence to older people. Even though children have the highest injury rates for all injuries combined, the elderly have the highest death rates and the highest dysfunction and disability rates from falls, fires and contact with hot substances, and vehicular crashes.

There are notable race and sex differences in injuries in the elderly. Women have higher rates of injury from falls than men. Men have higher injury rates from burns and motor vehicle crashes (including pedestrian injuries), and for each of the three categories of injury men have higher death rates than women. Before the age of 75, nonwhite males have the highest rates of death from injury. At 75, however, white males cross over to have a much higher rate of death from injury than do nonwhite males.

More than half the deaths due to unintentional injury in persons 65 and older are caused by falls. White men have the highest death rates from falls, followed by white women. More than a fourth of the injury fatalities for people 65 and older are from motor vehicle crashes. More than 9.3 per cent of all licensed drivers are 65 or older. Older drivers drive fewer miles than other people, and they tend to limit their driving to daytime and to relatively less stressful conditions. Nonetheless, when miles driven by drivers over 64 are taken into account, the relatively small number of crashes is equivalent to a crash rate exceeded only by the under‐25 age group. Pedestrian deaths account for more than a third of motor vehicle deaths to people 65 and older. The death rate from burns is higher in the elderly than in any other age group, including young children. In the event of thermal injury, old people are much less likely to survive.

Diminished ability to perceive hazard and to respond effectively contributes to higher injury rates among the elderly, as does lower injury threshold.
Pharmacology and Aging
Authors: VESTAL ROBERT F.
Published: April 2015

The elderly use more drugs than younger people, and often require multiple drugs, with the potential for drug interactions and adverse drug reactions. It is not known to what extent age per se may predispose to drug interactions. Furthermore, the toxicology of drugs in the elderly has received almost no systematic investigation. For example, are the elderly more susceptible than the young to the hepatotoxic effects of some drugs? Epidemiologic studies using standardized methodology, such as the Defined Daily Dose, are needed to compare drug utilization in both ambulatory and institutionalized elderly between countries and regions. This will provide the basis for the evaluation of the effects of educational programs aimed at promoting rational drug therapy in the elderly. Analysis of the differences on drug use and drug prescribing patterns in various countries may yield insight into the determinants of those patterns and suggest optimal educational approaches. Available evidence indicates that age‐related alterations in the physiology of drug distribution, drug elimination, and drug action are the substrata upon which disease‐related alterations in drug disposition and drug response are superimposed. Continued efforts to characterize these age‐related and disease‐related effects are needed. At present, generalizations are difficult because of conflicting data. Greater attention to subject selection, environmental factors, such as smoking and diet, and protocol design is necessary. As much as possible, research protocols should attempt to simulate the actual clinical use of the drug under study. This often means conducting studies at steady state after multiple dosing rather than only after a single dose. A longitudinal study using model compounds would be of great interest to help distinguish the effects of aging per se from those of disease. Wherever possible, pharmacodynamic studies should be combined with studies of pharmacokinetics. Gaps in our knowledge exist for all drug classes. Continued basic research in pharmacology and physiology is required to elucidate the mechanisms for the age differences observed in clinical studies. This research depends on the use of animal and in vitro model systems. Efforts to define the optimal animal or in vitro model(s) for human geriatric pharmacology are obviously important components of this basic research. Although compliance with therapeutic regimens is not necessarily worse in the elderly than in younger age groups, the consequences of errors in self medication may be more severe. Thus, further efforts are needed to develop ways of enhancing the comprehension and compliance of geriatric patients.
Status of Geriatric Medicine in the United States
Authors: ROBBINS ALAN , MATHER JOHN , BECK JOHN
Published: April 2015

Geriatrics has experienced a gradual and cyclical evolution in the United States. A considerable amount of attention has recently been focused on the status of geriatric medicine and the issue of specialty recognition. Numerous organizations within established medicine have developed position documents and are in the process of re‐examining their status. In the United Kingdom, physicians can now be designated as having a special interest in geriatric medicine, and Canada is proceeding with the development of a certificate of special competence in geriatric medicine under the auspices of the Division of Medicine, Royal College of Physicians and Surgeons. This paper presents hypotheses to account for the lack of organizational status in geriatrics, and arguments are examined regarding the need for specialty recognition. There is general consensus that geriatrics has an identifiable body of knowledge and skills and that there is need for a cadre of academic geriatricians and educators in geriatrics for students and residents. However, specialty recognition introduces conflict within established specialties that consider care of the elderly crucial to their existence. The options for special recognition, including a certificate of special competence, are described with their advantages and disadvantages. Substantial arguments favor some form of specialty recognition.
BOOK REVIEW*
Authors: Barzel Uriel S. , Bortz Walter M.
Published: April 2015

Other Ways of Growing Old—Anthropological Perspectives. Edited by Amoss PT and Harrell S. Stanford, California, Stanford University Press, 1981, 220 pp, $18.50
Alcohol Excess and the Senile Squalor Syndrome
Authors: KAFETZ KALMAN , COX MARIA
Published: April 2015

Two patients are described who fit the category of the senile squalor syndrome, i.e., the deterioration into squalor and self‐neglect by a patient not subject to dementia or serious physical impairment. It is suggested that alcoholism may be an important predisposing factor.
Falls among the Elderly
Authors: PERRY BRUCE C.
Published: April 2015

This paper summarizes the medical literature relevant to falls sustained by the elderly to highlight what is known about the magnitude of the problem, to identify those aged at risk, and to ascertain the risk factors for falling. While searching for general trends in the literature, the analysis concentrates on several characteristics of such studies, including the study populations, the measurement of risk factors, the measurement of outcome, and the systematic biases involved. Possible mechanisms are suggested for use of the profound influence of pre‐existing disease in the elderly as a predictor of falling and subsequent injury. On the basis of this analysis of the literature, suggestions are made about avenues for future research that would answer more definitively the questions remaining about falls among the elderly.
Iatrogenic Disease in Hospitalized Elderly Veterans
Authors: JAHNIGEN D. , HANNON C. , LAXSON L. , LaFORCE F. M.
Published: April 2015

To help determine whether or not the elderly are at unusually high risk for hospital‐related complications, a study was made of consecutive admissions involving 48 patients less than 65 years old (mean 50.3 years) and 174 patients more than 65 years old (mean 73.1 years). They were prospectively followed during their hospital stays, and were monitored daily. According to admission data, they were classified as: Group I, likely to die soon after admission; Group II, likely to die within a year; Group III, likely to live longer than a year. Complications were listed under the causal factors: trauma, infection, hospital procedures, drugs, and miscellaneous. About 90 per cent of all 222 patients in both age categories were in Group III. The overall complication rates were 29 per cent for patients under 65, and 45 per cent for those over 65 (P < 0.05). For the under‐65 Group III patients, the rates were 17 per cent and 42 per cent for medical and surgical patients, respectively; for the over‐65 patients, the rates were 40 per cent (medical) and 43 per cent (surgical). This indicated a major increase in complications among medical patients more than 65 years old. Procedure‐related problems were most common among surgical patients under 65. For over‐65 patients, the complication rates for procedure‐related, trauma, miscellaneous, infection, and drug toxicity categories were fairly evenly distributed within the range of 16.8–12.8 per cent, in that order. Major psychiatric deterioration was observed in 10.7 per cent of patients over 65, but in none of the younger subjects. Drug toxicity and traumatic complications were also more common in the older patients. These data confirm the disproportionately high incidence of iatrogenic disease in hospital patients over the age of 65. Several of these complications are amenable to control.
Use of Nutritional Supplements in an Ambulatory Elderly Population
Authors: HALE WILLIAM E. , STEWART RONALD B. , CERDA JAMES J. , MARKS RONALD G. , MAY FRANKLIN E.
Published: April 2015

The use of nutritional supplements by 3,192 ambulatory elderly participants in a health screening program is described. The 2,009 women used vitamin (45.5 per cent) and mineral (22.4 per cent) products with significantly greater frequencies than did the 1,183 men (34.0 per cent and 15.0 per cent, respectively); chi‐square, P < 0.01. The most commonly used vitamin products were multiple vitamins, multiple vitamins with minerals, vitamin E, and vitamin C; for minerals, the ranking was potassium chloride, calcium salts, and ferrous sulfate. Eighty‐two participants (2.5 per cent) reported the use of four or more supplements. Many older Americans are spending a great deal of money for nutritional supplements, whereas it would seem that the money could be better spent to improve the quality of their diet.
Medical Care in a Geriatric Psychiatry Unit: Impact on Psychiatric Outcome
Authors: WEINGARTEN CHARLES H. , ROSOFF LOIS G. , EISEN SUSAN V. , GROB MOLLIE C.
Published: April 2015

The medical care of 49 randomly selected patients admitted to a geriatric psychiatry evaluation unit was assessed to determine the impact on psychiatric care and outcome. Medical factors were identified as directly causing psychiatric symptoms in 12 of the 49 cases, whereas psychiatric decompensation was precipitated by medical illness in 25. Previously undiagnosed significant medical problems were found in ten patients. In 25 cases concomitant medical illness had a major effect on psychiatric treatment, and in 23 the course of the medical illness affected psychiatric outcome. Seventy‐nine per cent of the patients had at least moderately improved at the time of discharge, and most were able to return to their homes. Improvement in medical condition was correlated significantly with psychiatric improvement. Implications for the care of geriatric psychiatry patients are discussed.
Multiple Primary Malignant Tumors (MPMT): Study of 68 Autopsy Cases (1963–1980)
Authors: LEE TUNG‐KWANG , MYERS RICHARD T. , SCHARYJ MODESTO , MARSHALL RICHARD B.
Published: April 2015

Review of 8428 autopsies (1870 for known cancer) showed that 68 patients had had multiple primary malignant tumors (MPMT). Those 68 cases represented 0.8 per cent of all autopsies done, 3.6 per cent of all cancer autopsies. Diagnosis of MPMT was made only at autopsy in 24 cases (35.3 per cent). Thirty‐six patients were male, 32 female. Their average age was 64 ±usmn;2.3 years. Cancers were “synchronous” (diagnosed within a six‐month period) in 15 patients, “metachronous” (diagnosed at greater than six‐month intervals) in 49, and “combined” in four. Metastatic foci were seen in 53 patients. Fifty‐nine patients had two primary malignant tumors (PMTs); seven had three PMTs; one had four PMTs; and one had five PMTs, for a total of 148 tumors. Over half (53.1 per cent) of the second PMTs occurred within five years of the first PMTs. First PMTs were most common in the hematopoietic system and the cervix; second PMTs were most common in the lungs and the hematopoietic system. Second PMTs were less well differentiated than index PMTs. Forty‐four deaths had not been directly tumor‐related. Nineteen patients with metachronous MPMT lived more than ten years. Of 23 patients with one pulmonary PMT, 22 died within two years. Concomitant findings of pulmonary artery embolism, gallstone(s), thyroid or prostatic hyperplasia, and benign tumor were common in these patients. It is hoped that accumulation of data from this and other series of MPMT will provide insight into the clinicopathologic characteristics, the causes, and the interrelationships of these lesions that constitute primarily a disease of the elderly.
Geriatric Sexual Dysfunction: A Case Survey
Authors: KOFOED LIAL , BLOOM JOSEPH D.
Published: April 2015

This study examines questionnaire data obtained from a group of older persons with sexual dysfunction mistakenly referred through a newspaper column. These 35 respondents (28 men, seven women) were characterized by age (43–82 years), symptomatic sexual problems, and a willingness to write about them. They were chiefly men who had varying degrees of erectile failure and were negatively affected by the development of their problems. Two thirds had consulted a physician. The older subjects were more likely to be abstinent, to have total erectile failure (if men), to have known their physicians only a short time, and to describe their physicians as uninterested or pessimistic. Couples involving a medically ill wife, couples married for a long time, and couples who defined sexuality in a nonaffective way were less affected by the development of sexual difficulties. A small group of older men had become impotent because of prolonged abstinence related to lengthy illnesses of their wives. These findings indicate that some physicians show an age‐related bias in treating such patients; some contributory factors are outlined. The data may help clinicians in their counseling of such patients and in the identification of certain subgroups at risk. Directions are suggested for further systematic research.
Ethical Aspects of Primary Preventive Measures Among the Institutionalized Elderly
Authors: CRAIG THOMAS J.
Published: April 2015

For the interested physician, the primary prevention of medical illness if often considered a luxury or an optional exercise. This report illustrates the position that physicians caring for the institutionalized elderly have a strong ethical and perhaps legal obligation to institute primary preventive strategies, in view of their responsibility for total care of the patient. As an example related to cardiovascular mortality and morbidity, primary preventive strategies directed at cigarette smoking and immobilization appear to be clearly indicated. The absence of such preventive strategies could be construed as acceptance of intervention designed to increase morbidity and mortality.
Alcoholism in the Geriatric Population
Authors: HARTFORD JAMES T. , SAMORAJSKI T.
Published: April 2015

Alcohol abuse by elderly persons may be overlooked by clinicians because the effects of alcoholism on intellectual processes may be attributed to advancing age. In older patients, in whom liver and other organ functions may be reduced, even modest social drinking will impair cognitive abilities. Alcoholism is especially detrimental to older persons because 1) their blood levels of ethanol are higher than those in younger persons, and brain neurons may be more sensitive to the drug; 2) ethanol can disturb their sleep and sexual performance; 3) their cognitive functions may be significantly impaired by ethanol; and 4) for elderly patients, who commonly take a variety of drugs, ethanol and drug interactions are particularly hazardous.
The Black Aged
Authors: CARTER JAMES H.
Published: April 2015

Some of the problems associated with providing quality mental health care for aged blacks are discussed. It is postulated that treatment should be used selectively, not in terms of simplistic formulas or part‐truths about aged blacks, but on the basis of clinical indications in differential diagnosis. The essence of improved mental health for blacks, regardless of sex or age, entails an unrelenting struggle by mental health professionals toward the removal of all vestiges of racism.
Erythrocyte Aging Changes Evaluated by the Deoxyuridine Suppression Test
Authors: OKABE TADASHI , ISHIZAWA SUSUMU , ISHII TOSHIHARU , KATAOKA KUNIZO , MATSUKI SHUN
Published: April 2015

Many hematologic studies have shown that the erythrocyte count decreases while the size of the individual cell increases in the aged. This study was performed in order to (1) evaluate changes in the blood erythrocyte level and mean erythrocyte size in the elderly and (2) evaluate use of the deoxyuridine (dU) supression test to determine whether deficiency of vitamin B12or folate plays any role in age‐related changes of hematopoiesis. Selected for study were 102 healthy men whose ages ranged from 20 to 79 years. The erythrocyte count and hemoglobin level decreased significantly, whereas the mean corpuscular volume and mean corpuscular hemoglobin increased after 70 years of age. Fresh bone‐marrow cells were obtained from 10 young (20–38 yr) and 10 aged (70–82 yr) men. Wickramasinghe's dU suppression test was modified by application of an automatic cell harvester. The results were normal in both groups. Thus, the route of dU to dTMP in a DNA synthetic pathway appeared intact, and there was no evidence of B142or folate deficiency in the aged to explain the observed macrocytosis. However,3H‐thymidine uptake by nucleated bone‐marrow cells was significantly decreased, and the ratio of3H‐uridine to3H‐thymidine uptake was greater in the old group than in the young group. These results could be explained by altered nucleic acid metabolism (unbalanced cell growth) or by a change in the proportion of the different fractions of nucleated cells.