bluuebunny/crossref_metadata_2025 huggingface dataset:
A Concept of Loneliness in the Elderly*
Authors: WILLIAMS LULA M.
Published: April 2015

ABSTRACT: The author's concept of loneliness is described, especially as it concerns the elderly. An attempt is made to develop an understanding of the word, with its implications for guidance in the nursing profession. The nurse's defenses against her own feelings of loneliness and depression can inhibit therapeutic interactions with lonely or depressed patients. Appropriate nursing action depends upon the knowledge, correlation and use of many other concepts such as those related to dynamics of behavior, personality structure and development, or problem solving. Practical recommendations for nursing intervention are outlined. Emphasized is the necessity for the nurse to understand the concept of loneliness so that she may render effective service.
Evaluation of Goal Attainment in Geriatric Settings
Authors: CORNBLETH TERRY
Published: April 2015

ABSTRACT: Determination of the impact of programs designed to enhance the functional independence of geriatric residents requires prior specification of goals in terms that clearly indicate the desired outcomes. The Geriatric Resident Goals Scale (GRGS) is a listing of specific goals developed to provide a systematic means of assessing resident status and program effectiveness. For male residents in a VA Nursing Home Care Unit, the obtained internal consistency reliability coefficient was .97 (N = 198), and the reliability coefficient reflecting a combination of test‐retest and interrater consistency was .95 (N = 22). For a group of 178 residents, the GRGS was predictive of level of independence ratings (r = .82) and mental status (r = .71). The data showed the GRGS to be a highly reliable and valid means of assessing the functioning of geriatric residents, lending support to an assessment process based on a listing of specific goals. The GRGS can be viewed as a general procedure that is adaptable to a range of geriatric settings and programs.
Avoiding Diagnostic Errors in Admitting Patients to a Nursing Home
Authors: LOESER WILLIAM D. , DICKSTEIN EMIL S.
Published: April 2015

Sometimes the members of the medical profession have been castigated for unpreparedness and shortcomings in the management of nursing home populations because their pre‐admission diagnoses often have not agreed with the post‐admission evaluations. In contrast, the authors' survey of a local situation revealed a high degree of diagnostic accuracy in admissions to a nursing home. Discussed are appropriate steps that nursing‐home admission evaluators can take to ensure the avoidance of errors in the entrance diagnosis.
Improving the Quality of Life for the Elderly*
Authors: Mathias Charles McC.
Published: April 2015

The United States Senator from Maryland, as speaker at the Awards luncheon of the American Geriatrics Society (Washington meeting), presented his views on priorities in various health programs for the elderly, and asked for the Society's cooperation in making some of the difficult decisions that lie ahead. An important item is cost‐effectiveness. These decisions will affect every discipline involved in geriatrics, and have an important bearing upon the quality of life for the elderly. A better understanding is needed of the interaction between aging and disease, and the use of preventive measures.
Reduced Incidence of Endometrial Cancer among Postmenopausal Women Treated with Progestogens*
Authors: Gambrell R. Don , Massey Fred M. , Castaneda Tristan A. , Ugenas Aldonna J. , Ricci Corrine A.
Published: April 2015

A prospective study begun in 1976 to determine the incidence of endometrial cancer in postmenopausal women was undertaken because of the adverse publicity alleging an increased risk of endometrial cancer in women receiving estrogen therapy. A retrospective study for the year 1975 was added. During 8,170 patient‐years in the 3‐year 1975–1977 period, 14 endometrial malignancies were diagnosed, for an annual incidence of 1.7 per 1,000 women. During the 3,792 patient‐years of observation of estrogen‐progestogen users, the incidence of endometrial cancer was 0.5:1,000. The incidence of this carcinoma among estrogen users (8 cases during 2,088 patient‐years) was 3.8:1,000. The difference between these two groups was statistically significant (p < 0.01). One adenocarcinoma was detected in a patient who used estrogen vaginal cream for 7 months, for an incidence of 1.7:1,000 during 573 patient‐years of observation. In the untreated women, during 1,515 patient‐years, there were 3 endometrial cancers, for an incidence of 2.0:1,000. There was no significant difference between the untreated group and the estrogen users, and only a trend (p < 0.21) between the estrogen‐progestogen users and the untreated women. Synthetic progestogens were used to treat 199 women with endometrial hyperplasia (a precancerous lesion) for 3–6 months. The hyperplastic endometrium reverted to normal endometrium in 96.5 percent. The authors believe that all postmenopausal women with an intact uterus should be given the Progestogen Challenge Test, and the progestogen continued each month as long as bleeding follows. Such methods should be highly effective in preventing most endometrial cancer in these women.
The Vaginal Flora after Natural or Surgical Menopause
Authors: Blum Martin , Elian Inge
Published: April 2015

A study was made of the cervical and upper vaginal flora in menopausal women, in an attempt to determine whether such women are predisposed to infections when undergoing gynecologic operations. The series comprised 72 women (age range, 44–80 years) classified as follows: a) 35 with a natural menopause, b) 18 with a surgical menopause induced by abdominal panhysterectomy, and c) 19 postmenopausal women after vaginal hysterectomy performed for genital prolapse. The vaginal flora of these menopausal women consisted predominantly of Gram‐positive bacteria which, together with the Gram‐negative bacteria, conformed to the normal pattern of microorganisms in the vagina. Such bacteria also are found in women of child‐bearing age, but occasionally they can be pathogenic. Despite the inherent biohormonal changes of the menopause, expressed especially by the low estrogen level, 26.4 percent of the cultures in our study were sterile, even after major vaginal operations. Thus, the pattern of the vaginal flora, even though occasionally pathogenic, should not be a contraindication to gynecologic surgical procedures in postmenopausal women. Even when vaginal cultures show the presence of these bacteria, it does not seem necessary to use prophylactic antibiotic and hormonal therapy routinely. Rather, it should be given selectively, depending upon the local state of the tissues and upon the postoperative course.
Occult Progressive Renal Damage in the Elderly Male Due to Benign Prostatic Hypertrophy
Authors: Mukamel E. , Nissenkorn I. , Boner G. , Servadio C.
Published: April 2015

A review of the case histories of 345 patients who underwent prostatectomy showed that 1.7 percent (6 patients) had “occult and progressive renal damage” secondary to prostatic hypertrophy. All these men were over the age of 60 and the disturbances in micturition were so mild that the patients were unaware of, or chose to ignore them. The presenting symptoms were nonspecific and included generalized weakness, anorexia, nausea, constipation, and weight loss. Investigation revealed imparied renal function of varying degrees. Prostatectomy was associated with a dramatic improvement in all 6 patients. Physicians should be aware of the clinical entity of occult and progressive renal damage secondary to obstruction of the bladder outlet, especially in the elderly male. Uremia can develop with minimal urinary symptoms. Elderly men often suppress or deny their symptoms because of the fear of operation.
“Spontaneous” Atheroembolic Disease As a Cause of Renal Failure in the Elderly*
Authors: Varanasi Umamaheswara R. , Moorthy A. Vishnu , Beirne Gregory J.
Published: April 2015

An 86‐year‐old man with previous normal renal function was hospitalized because of renal insufficiency. He had a long history of atherosclerotic heart disease, mild hypertension and pulmonary embolism, requiring anticoagulant therapy. In view of the normal‐sized kidneys and absence of casts in the urinary sediment, a diagnosis of atheroembolic renal disease was made. The patient's renal function deteriorated, but he refused hemodialysis. Death occurred within a few weeks. At autopsy, severe aortic atherosclerosis was observed and atheroembolic renal disease was confirmed as the cause of renal failure. Occasionally, renal failure can be the sole manifestation of spontaneous atheroembolic disease. This possibility should be considered if the physician is called upon to establish the diagnosis when renal insufficiency develops in atherosclerotic patients.
Contributions of the Long‐Term Care Facility to the Medical Care of the Aged
Authors: Rodstein Manuel
Published: April 2015

Care of the aged in the United States by advanced long‐term care institutions has resulted in many important contributions to our knowledge of the aging process and disease over the past four decades. These institutions are characterized by well organized medical staffs, with full‐time medical directors who also serve as chiefs of the Medical Department and as stimulators and coordinators of research and teaching. These institutions provide comprehensive management, with laboratory, x‐ray and necropsy capabilities and multiple levels of care. Many serve as teaching centers and have affiliations with medical schools and university hospitals for house staff and postgraduate medical training. Several contributions to the medical literature on aging are described, among them being the earliest published in this country concerning pneumonia, cancer, arcus senilis, atypical and silent myocardial infarction, digitalis therapy, subacute bacterial endocarditis, calcific aortic stenosis and congenital heart disease. Fundamental papers have been published on a system of functional classification, attitudes toward death and dying, evaluation of mental status, the diagnosis and care of chronic brain syndrome, psychologic evaluation, the diagnosis and care of many ophthalmologic disorders, and the causes, incidence and prevention of accidents among the aged. The long‐term care institution, under proper circumstances, is an excellent site for good medical care, and significant contributions to research and teaching.
The Life Satisfaction Index‐Form A as Applied to Older Adults: Technical Note on Scoring Patterns
Authors: Ray Robert O.
Published: April 2015

The value of standardized scales for determining life satisfaction among older adults is being questioned, but use of the scales continues. The Life Satisfaction Index‐Form A (LSIA) in its many variations continues to be among the most widely used scales for this purpose. In a comparison of two scoring methods (36‐point vs. 18‐point) for the LSIA, the lack of a significant difference indicated that a 36‐point scale is not necessary. Caution in the use and interpretation of the variances between the two scoring methods is suggested.
Paget's Disease and the Nervous System
Authors: FELDMAN ROBERT G. , CULEBRAS ANTONIO , SCHMIDEK HENRY H.
Published: April 2015

ABSTRACT: Paget's disease usually is found in patients past the age of 40. Early presenting symptoms include headache, deafness, tinnitus, and pain due to radicular compression. The diagnosis is confirmed by radiographic features and elevated levels of serum alkaline phosphatase and urinary hydroxyproline. Bony overgrowth results in pressure on nearby soft tissues such as the brain, spinal cord, and certain peripheral nerves. The abnormally soft quality of the calvarial bone permits distortion by the weight of the brain. Dorsal inclination of the plane of the foramen magnum and the projection of the odontoid process into the posterior fossa lead to stretching of the brain stem over the odontoid process and the ventral margin of the foramen. Obstructive hydrocephalus may result. Sarcoma of the cranial vault may develop in cases of Paget's disease. Once cervicomedullary or spinal compression has occurred, surgical decompression may be necessary. Three drugs—calcitonin, disodium etidronate, and mithramycin—have been used with some benefit in the treatment of Paget's disease.
Amantadine in Senile Dementia: Electroencephalographic and Clinical Effects
Authors: MÜLLER H. F. , DASTOOR D. P. , KLINGNER A. , COLE M. , BOILLAT J.
Published: April 2015

ABSTRACT: Nineteen patients with senile brain disease (including 2 with parkinsonian symptoms) were treated with amantadine in an oral dosage of 200–300 mg daily. Seven showed definite clinical benefits such as increased alertness and decreased agitation, and 2 others showed slight benefits. However, in only one instance was the benefit maintained without complications. Toxic effects such as overactivity, anxiety and visual hallucinations were observed in 8 patients. Withdrawal effects (e.g., lethargy and staggering) occurred when amantadine was discontinued. The electroencephalograms (EEGs) of all 19 patients showed a frequency increase, chiefly of occipital alpha activity, and sometimes a return to normal, irrespective of clinical changes. Toxic side effects were associated with particularly prominent EEG acceleration. In 10 of the 19 patients, the clinical changes were further validated by additional psychologic assessments. Although the value of amantadine is limited when given in this way to patients with senile brain disease, it seems important to observe its effects in drug combinations aimed at correction of neurotransmitter imbalances.
Huntington's Disease: Current Concepts of Therapy*
Authors: GOETZ CHRISTOPHER G. , WEINER WILLIAM J.
Published: April 2015

ABSTRACT: Huntington's disease (Huntington's chorea), a degenerative disorder of the central nervous system, is inherited in an autosomal dominant pattern. Since there is no cure for this genetic disorder, therapy has been focused on pharmacologic manipulation of the involved neurotransmitter systems. In Huntington's disease, there is a functional predominance of striatal dopaminergic activity over antagonist cholinergic and possibly gaba‐minergic systems. Many dopaminergic antagonists and cholinergic and gaba‐minergic agonists are currently used in treatment. Supportive psychiatric care for affected persons and their families is an important therapeutic adjunct in the management of Huntington's disease. The eventual therapy will depend upon accurate identification of the primary genetic defect.
Geriatric Medicine: Model for Computer‐Oriented Research Analysis
Authors: DAS SANKAR K. , ANDERSON JOHN , KATARIA MOHAN S.
Published: April 2015

ABSTRACT: It is important to have accurate information derived from basic data about geriatric patients, not only for clinical management but to anticipate changes in the demand for services and the taking of preventive action. A model is presented for computer‐oriented analysis. The collection of data is designed to cover the specific physical, physiologic and social needs of the patients both in the hospital and in the community. It must also support effective action about these needs which involve not only usage of existing facilities but the planning of preventive measures and adjustment of the provision for care. In addition, it must support clinical research when necessary. Geriatric records have specific problems, not only those of the patient's identity and clinical data but also the maintenance of psychologic and social information so that the requirements for long‐term care can be assessed. This type of record facilitates comparison between groups of patients and allows measurement of inter‐hospital performance relating to medical care and the planning of social programs in the community. Such records furnish the background of a more detailed statistical analysis for indicating the direction of national policy. By this means the prevalence of medical, psychologic and social demand can be studied and various preventive actions taken, including the monitoring of geriatric facilities.
Idiopathic Hypertrophic Subaortic Stenosis as Observed in a Large Community Hospital: Relation to Age and History of Hypertension
Authors: PETRIN THOMAS J. , TAVEL MORTON E.
Published: April 2015

ABSTRACT: The character of idiopathic hypertrophic subaortic stenosis (IHSS) was studied retrospectively in a large community hospital for the six‐year period, 1968–1974. Cases were discovered by examining the records of the Cardiac Non‐Invasive Laboratory (phono‐ and echocardiography). Of the 46 cases of IHSS identified, 39 were in patients of the 50–81 age group. Thirty‐two (82 percent) of the 39 patients were women, and 25 (78 percent) of these had a significant degree of hypertension. The hypertension had been present for more than five years in 62 percent of the cases. In 84 percent of the elderly females, the cardiac murmur had been present for less than ten years, and in 65 percent for less than five years. There was no family history of IHSS. Eighteen of the 46 IHSS patients underwent cardiac catheterization which confirmed the accuracy of the cardiographic data in all cases. The results of this study indicated that IHSS is usually nonfamilial, predominates in elderly females, and tends to be acquired after a lengthy period of hypertension. Cardiographic data appear highly specific diagnostically, often rendering cardiac catheterization unnecessary. Previous studies have not clearly defined the role of hypertension in the development of IHSS, at least partly because of the highly selective nature of most series reported from referral centers. These series often contain large numbers of younger patients.
Fluphenazine Enanthate in the Outpatient Treatment of Late Paraphrenia
Authors: RASKIND MURRAY , ALVAREZ CARROL , HERLIN SUSAN
Published: April 2015

ABSTRACT: Fluphenazine enanthate parenterally was compared to an antipsychotic drug (haloperidol) given orally for the “crisis intervention” treatment of elderly outpatients with late paraphrenia. In the fluphenazine group, 11 of 13 patients improved, compared to only 3 of 13 in the oral drug group (p < 0.01). The superiority of fluphenazine probably was attributable to improved compliance with the prescribed regimen by patients receiving parenteral depot medication. Despite the advanced age of the subjects, significant adverse drug effects were uncommon.
Rehabilitation of a Patient with Lower‐Extremity Quadriprostheses
Authors: RAO P. NAGARAJA , FINNERTY BERNARD A. , RUSKIN ASA P.
Published: April 2015

ABSTRACT: A case report is presented that demonstrates the successful rehabilitation of an 84‐year‐old woman who had undergone successive surgical procedures resulting in bilateral total hip replacement and bilateral prostheses for below‐knee amputations, i.e., quadriprostheses. It is emphasized that age per se should not be a deterrent to energetic rehabilitation efforts.
Hypertension in the Elderly: Review of Therapy with a Hydroflumethiazide‐Reserpine Combination
Authors: ELKOWITZ EDWARD B.
Published: April 2015

ABSTRACT: A retrospective analysis revealed that 125 geriatric patients had been treated for mild to moderate essential hypertension with a combination drug, each tablet of which contained 50 mg of hydroflumethiazide and 0.125 mg of reserpine. The dosage schedule was one tablet once daily for most patients. The duration of treatment ranged from 1 to 93 months (mean, 22.1 months). After one month of therapy, the decreases in mean systolic (—18.3 mm Hg) and mean diastolic (—6.6 mm Hg) blood pressure were statistically significant and these initial reductions were well maintained over a 6‐year period, without signs of tachyphylaxis. Side effects were reported by 53 patients, but these usually were mild and typical of those associated with antihypertensive therapy; discontinuation of treatment was required in only 3 patients. Use of the hydroflumethiazide‐reserpine combination was associated with several significant advantages, including convenient once‐daily dosing, improved compliance, and decreased cost.
Clinical Pharmacy Involvement in a Geriatric Health Clinic at a High‐Rise Apartment Center
Authors: EBERHARDT REBECCA CHANEY , ROBINSON LAWRENCE A.
Published: April 2015

ABSTRACT: During an initial 9‐week period of involvement in the operation of a health clinic for ambulatory geriatric patients in three high‐rise apartment complexes, the activities and opportunities for a pharmacist and pharmacy students were documented. For 120 of the 550 geriatric residents of the center, medication histories were completed during the study period. These 120 patients reported a total of 270 medical problems. They were taking 366 prescription drugs (average, 3.9 per patient). During the 9‐week study, 43 drug interactions were documented, and about 25 percent of the patients interviewed complained of some untoward drug effect. The opportunities for pharmacist involvement and the educational opportunities for pharmacy students were demonstrated. The period since the initial 9‐week study has shown even greater acceptance and utilization of the pharmacy services, with an increased number of visits by patients.
Role of the Hypothalamus in the Aging Woman*
Authors: GREENBLATT ROBERT B. , NATRAJAN P. K. , TZINGOUNIS V.
Published: April 2015

ABSTRACT: Relationships between the hypothalamus and the pituitary in the aging woman are discussed under the following subheadings: synthesis and release of follicle‐stimulating and luteinizing hormones, estrogen receptors, other releasing factors, neurotransmitters, and the mechanisms of hot flushes and migrainoid headaches. The hypothalamus is the main regulator of pituitary function. In the female, the hypothalamic‐pituitary axis appears to remain functionally intact well into old age.
Auditing the Process of Care in a New Geriatric Unit
Authors: CHEKRYN JOANNE , ROOS LESLIE L.
Published: April 2015

ABSTRACT: To assess whether the objectives of a new Extended Care Unit were reflected in the care of the patients and in the outcome of that care, an audit of the patients' records was performed. The audit sample involved 101 geriatric patients who had been admitted to the Unit for rehabilitation therapy, and then discharged. The study included assessment of the records for compliance with individual audit criteria, examination of the records in terms of a composite audit score, and analysis of the relationship between these scores and three outcome indices. Although the audit did not show a significant correlation between recorded care processes and treatment outcomes, it did reveal the extent to which the Unit's goals were reflected in the care process.
Senile Confusion: Assessment with a New Stimulus Recognition Test
Authors: BRINK T. L. , BRYANT J. , CATALANO M. L. , JANAKES C. , OLlVEIRA C.
Published: April 2015

ABSTRACT: There is a need for rapid and convenient assessment instruments to test the aged for senile confusion due to organic brain syndrome (OBS). The Mental Status Questionnaire (MSQ) and the Face‐Hand Test (FHT) have certain limitations. A valid instrument must measure short‐term memory loss and recognition. Sixty‐two patients were examined in 17 different trials of the Stimulus Recognition Test (SRT), which involves 10 items. Each item classified the patients according to staff ratings (P < .001), MSQ scores (P < .005), and FHT scores (P < .005). The composite MSQ score on a scale of 0–10 also served to separate the patients according to staff ratings (P < .005). The SRT scores correlated .81 to .67 with the MSQ and FHT scores. The SRT does not show the same false positive patterns as the MSQ and FHT. For that reason, it constitutes a useful diagnostic supplement. Suggestions for further research are made.
Changes in Hormonal Activities Relative to the Severity of Essential Hypertension
Authors: ITO KAZUKI , KUBOTA TETSUHIRO , YAMADA TAKASHI , TAWATA MASATO , TSUKUI TOMOMICHI , NAGATA HAJIME , IZUMIYAMA TOMIO , KONO SHIRO , KAMATA KAZUO
Published: April 2015

ABSTRACT: Endocrine activity in patients with essential hypertension was studied by measuring the urinary excretion of catecholamines, prostaglandin E (PGE) and cyclic adenosine monophosphate (cAMP). Simultaneously, plasma renin activity, concentrations of serum sodium, potassium, blood urea nitrogen (BUN) and creatinine were determined. Systolic blood pressure and BUN increased progressively with age until the sixth decade. Urinary excretion of norepinephrine was correlated with the systolic blood pressure. In contrast, plasma renin activity and urinary excretion of PGE decreased progressively with the increase in systolic blood pressure. Although the cause of essential hypertension is not known, it is suggested that hypertension accelerates the aging process in the kidney and thus decreases renal PGE synthesis. This decrease of PGE in turn causes a reduction of plasma renin activity, possibly either by accelerating the retention of sodium and water or by failing to stimulate renin synthesis. A decrease of PGE may also potentiate the vasopressor action of norepinephrine.
Emergency Transvenous (Subclavian) Cardiac Pacing in Elderly Patients
Authors: BARTECCHI CARL E.
Published: April 2015

ABSTRACT: Emergency transvenous cardiac pacing can be performed in elderly patients rapidly, effectively, and with few complications. An experienced physician using the subclavian route usually can achieve effective pacing with equipment priced well within the budget of most community hospitals. Data on 36 patients (age range, 75–94 years) are presented.
Prosopo‐Affective Agnosia as a Symptom of Cerebral Organic Disease
Authors: KURUCZ JANOS , FELDMAR GABRIEL
Published: April 2015

ABSTRACT: A previously described test for prosopo‐affective agnosia (impairment of facial affect recognition) had been applied in 14 disoriented elderly patients with chronic organic brain syndrome, 14 fully oriented elderly patients with non‐organic psychiatric disorders, and 14 normal volunteers. In this re‐test study of 37 of the 42 subjects, after a six‐month interval, the test was found to be reliable (r = .75, p < .001). The test was also more sensitive in detecting organic disorders than were other frequently applied neuropsychiatric tests. Prosopo‐affective agnosia (PAA) appeared unrelated to prosopo‐agnosia (PA) (r = .082, ns). Some patients who had the ability to recognize famous faces and faces of ward personnel were severely impaired in the ability to recognize facial affect. The deterioration was more pronounced for the recognition of sadness and anger than for happiness, indicating that patients with this impairment had reverted to an infantile mode of facial‐affect recognition. This reversal is another example of the neurologic regression that characterizes dementia.
Cardiovascular Side Effects of Long‐Term Therapy with Tricyclic Antidepressants in the Aged
Authors: RODSTEIN MANUEL , OEI LIEM SOM
Published: April 2015

ABSTRACT: In a study to determine the nature and frequent cy of cardiac side effects during long‐term administration of tricyclic antidepressant drugs in usual dosages in the aged, 32 geriatric patients were followed for an average of 36.6 weeks. Ten of them received amitriptyline in a daily dosage of 20–75 mg for 53 weeks (average); in 2, electrocardiographic side effects developed, viz, inversion of the T waves or evidence of acute coronary insufficiency. Imipramine was administered to 21 patients in a daily dosage of 20–100 mg (average, 66 mg) over a period of 40 weeks; in 3 instances major side effects developed‐intermittent left bundle‐branch block, acute coronary insufficiency with node dysfunction, or T‐wave inversion with sinus tachycardia; in 1 instance there was a minor side effect, viz, tachycardia only. In 1 patient, acute myocardial infarction developed after two 10‐mg doses of nortriptyline. Five of the 7 patients with cardiac side effects had prior organic heart disease. It was concluded that the incidence of cardiac side effects in aged persons given tricyclic antidepressant drugs in the usual therapeutic dosages for a prolonged period is great enough to warrant frequent careful monitoring of cardiac status during therapy.
Development and Application of the Extended Scale for Dementia
Authors: HERSCH EDWIN L.
Published: April 2015

ABSTRACT: As part of an interdisciplinary study of organic dementia, a psychologic test for assessing the degree of dementia—the Extended Scale for Dementia—was developed through the expansion and rescoring of the original Mattis Dementia Scale. Statistical analyses of the 23 test items resulted in a scoring scheme which includes the “weighting” of items for scoring purposes. The test was successfully administered to 90 subjects from 6 hospitals in the London (Ontario) region. With use of the Extended Scale, it was possible to discriminate between dementia and non‐dementia groups of psychogeriatric inpatients and to correlate the findings closely with those of another measure of the degree of dementia, viz, the London Psychogeriatric Rating Scale (Ment.). Dementia patients who were retested after 6‐month and 12‐month intervals showed a significant decline in scores. No significant scoring differences were noted between males and females or between Alzheimer dementia and multiinfarct dementia.
The Elderly Patient in the Coronary Care Unit. I. Acute Myocardial Infarction
Authors: BERMAN NEIL D.
Published: April 2015

ABSTRACT: In a Coronary Care Unit (CCU) with no age barrier for admission, 21 percent of the patients admitted in 1976 were aged 70 or older. Myocardial infarction was documented in 55 of 130 elderly patients. The overall incidence of arrhythmias was similar to that for younger patients. The mean duration of stay in the unit and the CCU mortality (9.1 percent) were similar in both elderly and younger patients, as was the in‐hospital mortality rate. Of the patients who survived hospitalization, 75.6 percent were still living 18.1 months after the myocardial infarction. The elderly patient is as likely as the younger one to benefit from admission to a CCU.
A Psychogeriatric Assessment Program. V. Three‐Year Follow‐Up*
Authors: DASTOOR D. P. , KLINGNER A. , MÜLLER H.F. , KACHANOFF R.
Published: April 2015

ABSTRACT: In 1974, a 10‐month diagnostic evaluation of 80 newly admitted psychogeriatric patients was undertaken. The diagnostic categories were functional versus organic brain disease. The present report deals with results of a follow‐up evaluation three years later. to assess the prognostic validity of our measures, the initial 1974 data on survivor and nonsurvivor groups were studied, and some of the tests were repeated in 35 of the 40 survivors. Statistically significant differences between survivors and nonsurvivors were found in both “organic” and “functional” groups, with respect to performance on psychologic and psychophysiologic tests, and the level of social functioning before admission. The death rate was significantly higher in the group with organic disease.
Unsuspected Hypertrophic Subaortic Stenosis in the Elderly Diagnosed by Echocardiography
Authors: BERGER MARVIN , RETHY CHARLES , GOLDBERG EMANUEL
Published: April 2015

ABSTRACT: Idiopathic hypertrophic subaortic stenosis (IHSS) occurs more commonly in the elderly than is generally believed, and is often unsuspected. In 26 patients above the age of 60, the diagnosis was recognized in only 7 (27 percent) prior to echocardiography. Symptoms included dyspnea in 17, chest pain in 16, and dizziness or syncope in 8 patients. In 10 patients, establishing the correct diagnosis led to therapy with propranolol, with or without discontinuation of digitalis; in 7 of these, the chest pain was significantly reduced. An accurate diagnosis is particularly important because drugs that are useful in other forms of heart disease may have adverse effects in IHSS. Echocardiography is the diagnostic procedure of choice and is indicated in the presence of an unexplained systolic murmur, especially when it is associated with chest pain, syncope or left ventricular hypertrophy.
Pneumonia and Psychotropic Drug Use in Elderly Psychiatric Patients
Authors: Craig Thomas J. , Bracken Joan
Published: April 2015

A study of the use of psychotropic drugs among 30 elderly psychiatric patients with pneumonia (15 of whom died), in comparison to the general elderly population of the hospital, revealed a negative association between the use of psychotropic agents and the development of pneumonia. The factors of age, sex, pre‐existing illness, and organism virulence/patient resistance were all associated with death from pneumonia. However, the present findings do not support the hypothesis that psychotropic drugs are implicated in pneumonia deaths among elderly psychiatric patients.
Human Neurologic Function and the Aging Process†
Authors: Potvin A. R , Syndulko K. , Tourtellotte W. W. , Lemmon J. A. , Potvin J. H.
Published: April 2015

Sixty‐one normal men whose ages ranged from 20 to 80 years were evaluated on two occasions by means of a comprehensive series of 128 instrumented tests of neurologic function. The tests measured cognition, vision, strength, steadiness, reactions, speed, coordination, fatigue, gait, station, sensations, and tasks of daily living. The reliability of each test measure was determined, and any measure found unreliable (r ≤ 0.41) was not further analyzed. Significant age‐related linear decreases were found for almost all neurologic functions. The declines over the age span varied from less than 10 percent to more than 90 percent for different functions. For the upper extremities, the largest declines (> 50 percent) were in hand‐force steadiness, speed of hand‐arm movements, and vibration sense; for the lower extremities, the largest declines were in one‐legged balance with eyes closed and in vibration sense. For 13 of 14 tests in which significant dominant body‐side effects were found, larger losses in function with aging were observed on the dominant body side. Upon re‐testing 7–10 days later, the subjects improved their scores by more than 5 percent on only 17 tests, 9 of which concerned the activities of daily living. No significant differential learning effects were found across age groups. The results point to the importance of developing a data bank on age‐based neurologic function so that therapeutic effects can be evaluated in terms of age‐ and sex‐matched normal functioning.
Evaluating Patients’ Warfarin Requirements
Authors: Jones Brian R. , Baran Andrij , Reidenberg Marcus M.
Published: April 2015

Seventy consecutive patients receiving warfarin as an anticoagulant were evaluated for the relationship between the response to the loading dose of warfarin and the response to the maintenance dose. No patients were excluded because of complicating diseases or the concurrent use of other drugs. There was a moderate correlation (r = 0.54, p < 0.01) between response to the loading dose and response to the maintenance dose. Thus, a relatively weak response to a loading dose of warfarin can be used to predict a need for a relatively large maintenance dose in unselected patients requiring anticoagulant therapy. Age seems to be a relatively weak determinant of warfarin sensitivity. Other factors such as the genetic control mechanism, concurrent drug therapy, and complicating diseases apparently are more important determinants.
Posthemiplegic Shoulder‐Hand Syndrome, with Special Reference to Related Cerebral Localization
Authors: Eto Fumio , Yoshikawa Masaki , Ueda Satoshi , Hirai Shunsaku
Published: April 2015

Seven autopsy cases of shoulder‐hand syndrome following hemiplegia were studied with regard to cerebral localization. One of them showed an isolated brain lesion in the premotor area due to a metastasis from malignant melanoma. Four other cases with cerebral infarction and one with glioblastoma multiforme showed massive brain lesions involving the frontal and parietal lobe cortex in the area supplied by the middle cerebral artery. The seventh case showed a hemorrhagic cerebral lesion in the lentiform nucleus. The most common overlap area in 6 of the 7 cases was located in the premotor region including the anterior part of the motor region. The shoulder‐hand syndrome following hemiplegia always develops on the side contralateral to the brain lesion which might cause a unilateral longstanding autonomic dysfunction. As corroborated in a review of the relevant literature, a lesion in the premotor area appears chiefly responsible for the primary mechanism of the shoulder‐hand syndrome in post‐stroke hemiplegia.
Oral versus Intramuscular Vitamin Supplementation for Hypovitaminosis in the Elderly
Authors: Baker Herman , Frank Oscar , Jaslow Seymour P.
Published: April 2015

Thiamin, folate, biotin, riboflavin, nicotinates, pantothenate, carotenes, and vitamins B6, B12, A, E and C were measured in the blood of 228 elderly ambulatory residents of a nursing home. Their mean age was 87 years (range, 60–102). None had undergone major surgical procedures; their diet was good, and each had received at least one multivitamin pill every day for 3 to 5 months before the study. A comparison group of 204 healthy volunteers, aged 20–50, was also studied. Of the 228 elderly subjects, 88 (39 percent) showed vitamin deficits despite oral vitamin supplementation. Single and multiple deficits of vitamin B6, nicotinate, vitamin B12, folate, and thiamin were found. Three months after a single intramuscular injection of multivitamins (with no other vitamin supplementation), these deficits were no longer detectable in the blood of 89–100 percent of the vitamin‐deficient elderly. Intramuscular rather than oral vitamin supplementation is a more effective method for maintaining adequate blood levels of vitamins in the elderly; the intramuscular route apparently promotes saturation of tissue stores with enough vitamins to meet the needs, and thus obviates problems of vitamin malabsorption possibly due to drug interference or small‐bowel atrophy.
Effect of Exercise on Aging—Effect of Aging on Exercise†
Authors: M. Bortz Walter
Published: April 2015

The coincidence of age changes with alterations in body structure and function is striking. Increasing evidence indicates that many of the changes commonly attributable to aging can be retarded by an active exercise program. Physical exercise, properly supervised, is a safe and widely applicable form of therapy.
The Diagnosis of Depression in the Elderly†
Authors: Blazer Dan
Published: April 2015

The reported prevalence of depressive symptomatology among the elderly ranges from 5 to 65 percent in hospital and community populations. Depression is considered the most common emotional disorder of advanced age. One of the chief diagnostic problems has been the lack of differentiation between disorders manifested by dysphoric or depressive symptoms. Recent work on operational criteris, as exemplified in the Third Edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM‐III) provides a basis from which the diagnosis of depression can be made and subgroups of elderly depressed subjects can be delineated. A community survey involving a stratified random sample of 997 persons aged 65 or older living in Durham County was completed in 1972. An 18‐item subscale eliciting depressive symptomatology was abstracted from the survey questionnaire and submitted to factor analysis, tests of reliability, and association with clinical diagnosis. The instrument proved to be a useful means of identifying persons with depressive symptomatology, as outlined in DSM‐III. It also can be used for epidemiologic studies of depression in the elderly.
Multiple Primary Neoplasms in the Elderly
Authors: Howell Trevor H.
Published: April 2015

The frequency of multiple primary neoplasms in the elderly was studied in three personal series of autopsy cases. Comparison with the results of other workers showed a range of 0.6 percent to 36 percent of all neoplasms, verified at autopsy.
Bartter's Syndrome in a 74‐Year‐Old Woman: Response to Anti‐Inflammatory Agents
Authors: Gordon Michael , Pollard Alan
Published: April 2015

The occurrence of Bartter's syndrome is described in a 74‐year‐old woman with a fractured hip. She showed hypokalemia and elevated levels of plasma renin and aldosterone. Only with difficulty did large doses of potassium supplementation raise the serum potassium level. After discontinuation of the exogenous potassium, there was a good response to treatment with antiinflammatory agents such as indomethacin and aspirin.
Aging and Mastication: Changes in Performance and in the Swallowing Threshold with Natural Dentition†
Authors: Feldman Roy S. , Kapur Krishan K. , Alman John E. , Chauncey Howard H.
Published: April 2015

Few comprehensive studies of oral function have been conducted on adult populations. A “Longitudinal and Cross‐Sectional Study of Oral Health in Healthy Veterans” was activated at the VA Outpatient Clinic in Boston in 1969; it included general oral and dental examinations as well as tests of masticatory performance and the swallowing threshold. The current investigation involved 863 subjects from the “Dental Study” who had either their natural teeth or a fixed replacement for missing teeth. Masticatory performance as measured by the subject's ability to reduce a test portion of cut carrot by a mandatory number of chewing strokes remained constant for persons with complete or partially compromised natural dentition. Swallowing threshold performance as measured by the particle size acceptable for swallowing remained constant for persons with complete dentition. Tooth loss significantly decreased the swallowing threshold performance and increased the particle size which the subject was willing to swallow. Older subjects increased the number of chewing strokes and the time required for this test, an observation not related to performance as measured by final particle size. Only with compromised dentition, however, did this increased effort result in increased performance. The results of this study indicate the persistence of masticatory performance (fixed number of strokes per second) with age, and also indicate an age‐related and dentition‐related increase in the effort expended by the subject to prepare the test food for swallowing.
Anemia in Institutionalized Elderly Patients†
Authors: Kalchthaler Thomas , Tan M. Eunice Rigor
Published: April 2015

In a one‐year period (1976–1977), 161 residents of a long‐term facility were evaluated. There were 44 men and 117 women. According to criteria established by the World Health Organization, 64 residents (40 percent) were anemic. The incidence was greater for women than for men. The peak incidence occurred in the 71–80 age group for women, and in the 90+ age group for men. Iron deficiency secondary to surgical procedures, gastrointestinal bleeding or anticoagulant therapy was the most common cause of correctable anemia. Of the 64 anemic patients, 42 percent responded to therapy. Anemia among the elderly in institutions is often reversible, unlike the anemia of chronic disease. Evaluation should include a careful history and physical examination plus readily available laboratory findings. Invasive procedures are rarely indicated.
Geriatric Preventive Health Maintenance
Authors: Morrison John D.
Published: April 2015

A preventive approach to geriatric health care should include periodic and systematic assessment of the physical, mental and social status of the elderly person. This article is a review of the important aspects of geriatric health maintenance and calls for more American data from the ambulatory‐care setting, to aid in further definition of the preventive approach.
High‐Density Lipoproteins and Peripheral Vascular Disease in Octo‐ and Nonagenarians
Authors: Schneider J.
Published: April 2015

In a medical service for ambulant patients, 180 unselected octo‐ and nonagenarians were studied. They showed high‐density lipoprotein (HDL) values similar to those reported for younger age groups. In 81 patients, a combination of various noninvasive angiologic techniques was used in addition to the history and physical examination. The frequencies of the clinical signs of peripheral arterial disease, and of stenoses and occlusions in the lower‐limb vessels, differed significantly between three HDL‐cholesterol subgroups, being highest in the group with the lowest HDL values.
Direct Skin Microscopy as an Aid in the Early Diagnosis of Precancer and Cancer of the Skin in the Elderly
Authors: Goldman Leon
Published: April 2015

As part of the routine physical examination of the elderly, the skin, especially on the commonly exposed areas of the face, neck, hands and forearms, should be examined for early signs of precancer and cancer. Various lesions are described. The early signs of precancerous actinic keratoses usually are missed without a special examination which includes the use of magnifiers or the new skin microscope. This microscope is a long focal‐lens stereobinocular instrument that can scan large areas of skin for the early detection of precancer and cancer. As part of the routine examination of elderly patients, it is a valuable aid in the practice of preventive geriatric medicine.
Erythrocyte Sedimentation Rate: The Normal Range in the Elderly
Authors: Sharland D. E.
Published: April 2015

A study was made of the erythrocyte sedimentation rate (ESR) in 258 normal nonhospitalized elderly subjects (189 women and 69 men). Their ages ranged from 70 to 89 years. Those who had been followed for at least one year showed a mean ESR of 13 mm/hr, with a range of 3–65 mm. A subgroup of 55 (47 women and 6 men) who had been followed for periods of 3 to 11 years showed a mean ESR of 14 mm/hr, with a range of 3–69 mm. The findings indicate that an ESR above the accepted normal range may be consistent with continued good health in the elderly. Thus the ESR determination may be of very limited diagnostic value in this age group.
An Overview of Neuropsychiatric Disturbances in the Elderly
Authors: Shraberg David
Published: April 2015

In no other period of life than old age do neurophysiologic alterations seem to affect behavior and cognition so significantly. Consequently, the relationship between neurology and psychiatry remains substantial when attempts are made to understand and deal with the many problems of aging. This study concerns improvement in the organization of such an approach to the neurologic and psychiatric problems of the elderly and to various interdisciplinary factors. Special consideration is given to changes in the central nervous system with aging, and to the differential diagnosis of dementia and pseudodementia.
Crystal‐Associated Arthropathies: What's New in Old Joints†
Authors: Pritzker Kenneth P. H.
Published: April 2015

Degenerative arthritis in the aged includes two major disease categories—osteoarthritis and the crystal‐associated arthropathies. The crystals chiefly involved are monosodium urate (gout) and calcium pyrophosphate dihydrate (CPPD), although several others (e.g., cholesterol, brushite and apatite) have been implicated. This report illustrates how the newer diagnostic techniques such as polarized‐light microscopy, analytical electron microscopy and x‐ray microdiffraction have augmented knowledge concerning diseases associated with articular crystal deposition. For example, diffraction techniques are required for accurate identification of the apatite crystals found in synovial fluid effusions and in the matrix vesicles of degenerate cartilage. According to ultrastructural studies, monosodium urate crystals found in tophi, joint surfaces and effusions show a distinct morphology. Present in inactive joints, the crystal surfaces are bare; in acute gout, the crystals are covered with mucin, confirming the observation that protein binding to crystals is necessary for inflammation to proceed. CPPD disease is by far the most common crystal‐associated arthropathy affecting the aged. The incidence of CPPD deposits in articular tissues increases with age but, in contrast to gout, affects both men and women. The pathogenesis of CPPD disease is a mystery, but factors under investigation include matrix abnormalities, ionic imbalances, and enzyme disorders.