bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Nylidrin Hydrochloride in the Treatment of Cognitive Impairment in the Elderly*
Authors: GARETZ FLOYD K. , BARON JESSE J. , BARRON PHYLLIS B. , BJORK ARVIS E.
Published: April 2015

ABSTRACT: A double‐blind study was conducted on the effects of nylidrin hydrochloride versus placebo in 60 patients with mild to moderate symptoms of chronic brain syndrome. Their ages ranged from 65 to 99 years. Preliminary results indicated that nylidrin HCI (a vasodilator) is a relatively safe therapeutic agent and more effective than placebo in ameliorating the symptoms of cognitive impairment associated with aging, on both a short term (3‐month) and a long‐term (9‐month) basis. In a dosage of 24 mg daily, it reached its peak effectiveness after 3 months of use.
A New Geriatric Application of Electrocardiographic Treadmill Testing in an Office Setting*
Authors: SCHWIMMER JULIUS
Published: April 2015

ABSTRACT: An accepted method of measuring exercise tolerance was applied exclusively to geriatric practice for the purpose of exercise prescription. This stress testing was performed to minimize the risks of introducing exercise in an elderly population, and to restore or maintain elderly persons at their own optimal level of function, for life. As no geriatric testing protocol was available, two standardized protocols were chiefly used to start the trial program in March, 1978. A geriatric modification devised by the author is described. During the first month of the study, in a physician's office, ECG‐monitored treadmill testing was conducted without mishap in 175 patients (age range, 60–89 years). All but 4 of the subjects (98 percent) led habitually sedentary lives, and documented coronary heart disease was present in about one‐fourth of the series. The initial test data in this proposed continuing study are summarized. The methods for candidate selection, the safety precautions, and the test procedure are outlined. The distinction is made between testing by functional grades and testing to maximal levels. Information obtained from this stress test is an integral part of the individualized exercise prescription for each geriatric subject.
Cultural and Sex Differences in Dietary Patterns of the Urban Elderly
Authors: HUNTER KATHLEEN I. , LINN MARGARET W.
Published: April 2015

ABSTRACT: A group of 182 elderly subjects (91 females, 91 males; 94 blacks, 88 whites) were interviewed with respect to background data, dietary habits, and health variables. Analysis of variance showed race and sex differences with respect to meal patterns and quality of diet. In addition, correlational analyses revealed associations between quality of diet and social class, education, health status, and the smoking of cigarettes. Associations were strongest for the black subjects.
Modern Ideas About Organization of Services for Elderly Patients in Hospitals and Nursing Homes in the Netherlands*
Authors: SCHOUTEN J.
Published: April 2015

ABSTRACT: The system of nursing homes in the Netherlands, and the advantages of the new department for geriatric assessment in the Municipal Hospital in Amsterdam are discussed. Included are admission and discharge data on 694 patients in the Geriatric Department in 1977, and also a list of the more common diagnoses, classified according to body system and disease.
Hyperthyroidism in the Elderly
Authors: KAWABE TETSUYA , KOMIYA ICHIRO , ENDO TOYOSHI , KOIZUMI YOICHI , YAMADA TAKASHI
Published: April 2015

ABSTRACT: In 65 elderly hyperthyroid patients (age range 50–78 years), sex differences, signs and symptoms and thyroid function were studied and the data were compared with those on 48 young hyperthyroid patients (age range 20–29 years). The incidence of hyperthyroidism was 3.5 times higher in females than in males among the young patients, whereas it was approximately equal in males and females among the elderly patients. Signs and symptoms conformed with the textbook description in the young subjects but not in the elderly ones. Measurements of serum triiodothyronine (T3) and thyroxine (T4) proved useful in preventing false diagnoses in elderly patients with atypical symptoms. In some elderly subjects with marginal increases of serum T3 and T4 concentrations, measurement of serum thyroid‐stimulating hormone (TSH) after administration of thyrotropin‐releasing hormone (TRH) was required to achieve an accurate diagnosis. Serum T3 and T4 levels and the thyroidal uptake of radioiodine were slightly but not significantly lower in the elderly than in the young patients. A high titer of circulating thyroid auto‐antibody in the elderly may be related to this slight decrease in thyroid function. Serum T3 levels were significantly lower in the elderly than in the young subjects; this suggests impairment of peripheral monodeidination of T4. Any abnormal serum of T4, T3 and TSH before and after administration of TRH could easily be restored to normal by treatment with antithyroid drugs in the elderly patients.
Active Rosette‐Forming T Cells in the Elderly*
Authors: NEILAN BARBARA A. , TADDEINI LUIGI
Published: April 2015

ABSTRACT: The numbers and percentages of active rosette‐forming T cells were measured in two age groups, to assess the effects of aging. The study included 21 healthy persons in the 20–40 age group and 25 persons without major disease in the 60–85 age group. In the younger subjects the number of rosette‐forming cells (RFC) averaged 1430 ± 463/cu mm (mean and S.D.), a count not significantly different from that in the older subjects (1443 ± 398/cu mm). Likewise, the active RFC count in the 20–40 age group (526 ± 185/cu mm) and that in the IJO‐85 age group (558 ± 197/cu mm) were not significantly different. There was no difference for the percentage total RFC (young 78 ± 4%, elderly 78 ± 6%) or the percentage active RFC (young 29 ± 7%, elderly 30 ± 6%). For the total lymphocyte count or the B lymphocyte count, there was no difference between the two groups of subjects. It is concluded that T lymphocytes, measured as total and active rosette‐forming cells, are not decreased in healthy older persons.
Treatment of Chronic Atrial Fibrillation in the Elderly, Assessed by Ambulatory Electrocardiographic Monitoring
Authors: Wang R. , Camm J. , Ward D. , Washington H. , Martin A.
Published: April 2015

This study concerns 8 elderly patients with age‐related chronic atrial fibrillation that required control of the ventricular response. The effects of oral administration of placebo, pindolol, verapamil, digoxin and digoxin + pindolol were assessed (each for a week) during three daily activity and sleep sessions, over a six‐week period. Cardiac rhythm was monitored by taped electrocardiograms. Either digoxin or pindolol was effective, but digoxin was the best tolerated of all the drugs. A combination of pindolol and digoxin reduced the maximum ventricular rate without further depression of the minimum ventricular rate. Digoxin seems to be well tolerated in the control of atrial fibrillation in the elderly, and beta blockade may be a useful therapeutic adjunct.
Aspirin Absorption from a Feeding Jejunostomy
Authors: Nelson Edward B. , Levitt Jacqueline R.
Published: April 2015

In a 67‐year‐old man who had a feeding jejunostomy because of dysphagia paralytica, the absorption of aspirin was measured in terms of serum salicylate concentration. A 975‐mg dose of aspirin was given as a slurry in water directly into the feeding tube. Peak serum levels of salicylate were well correlated with those in previous studies of aspirin absorption by the oral route in a geriatric population. However, unexpectedly, the half‐life of the drug in this patient was twice as long (7.5 hours) as that found in six previous studies (3.7 hours) of elderly patients given similar doses.
Health and Early Retirement Decisions†
Authors: Holtzman Joseph M. , Berman Harry , Ham Richard
Published: April 2015

Health and economic considerations have consistently played important roles in retirement decisions. Increases in early retirement benefits by some employers have increased the incentive to retire early, thus inducing a change in the health and economic relationships. During the three months following implementation by a large manufacturing firm of a labor contract which included substantial improvement in early retirement benefits, structured interviews were conducted with 45 employees who had chosen early retirement and 35 eligible employees who had chosen to continue working. Data are presented on the relationship between health and retirement decisions, and on the differences between early retirees and non‐retirees in regard to perceived health status, job satisfaction, potential for continued employment, leisure involvement, and morale. Implications for the primary care physician's interactions with workers who face early retirement are discussed.
Impact of Mental Disorders upon Elderly American Indians as Reflected in Visits to Ambulatory Care Facilities†
Authors: Rhoades Everett R. , Marshall Melody , Attneave Carolyn , Echohawk Marlene , Bjork John , Beiser Morton
Published: April 2015

In order to assess the impact of mental health problems among elderly American Indians, a study was conducted on the utilization patterns of ambulatory care facilities by various age groups of Indians. Since most health care of Indians is rendered by the Indian Health Service (IHS), data obtained from IHS computer centers provided a reasonable index of disease patterns. Because the elderly have constituted such a small fraction of the Indian population, they have not heretofore received significant attention. However, their problems are rapidly increasing. By adjusting the frequency of visits according to population, an estimate of visit “rates” was made. These rates showed one visit for every 10 persons in the 0–44 age group, one for every 5 persons in the 45–54 age group, but only one visit for every 25 persons in the 65+ age group. Most of the visits by older Indians concerned “social” problems rather than “mental” disorders as such. These data provide information that should prove especially helpful in the design of social and health programs for elderly Indians.
Use of Chlorophyllin in the Care of Geriatric Patients
Authors: Young Richard W. , Beregi Joseph S.
Published: April 2015

In a test group of 62 geriatric nursing home patients, the administration of chlorophyllin tablets was found to be helpful in controlling body and fecal odors. It aided also in easing chronic constipation, served at times as a useful and morale‐building placebo, and assisted in abating excessive flatus. No toxic or other ill effects were observed. Bacteriologic studies failed to confirm reports in the literature of antibacterial properties for chlorophyllin. Further investigation of this possibility is recommended.
Diplopia in the Aged: Etiology and Management
Authors: Cinotti A. , Stephens E. , Wilcox L. , Stephens G. M. , Caputo A.
Published: April 2015

A description of diplopia, its causes, compensating mechanisms, and therapy is presented. Diplopia may be of benign origin, e.g., presbyopia or convergence insufficiency, but in the elderly it can be a warning of a severe local disorder or systemic disease. Early medical diagnosis should be a prime objective. Most of these disorders, if identified in time, can be cured or at least relieved by appropriate medical and surgical treatment.
Chronic Obstructive Pulmonary Disease: Rehabilitation Program with Continuation on an Outpatient Basis
Authors: Alkalay Israel , Kaplan Abram S. , Sharma Ran , Kimbel Philip
Published: April 2015

A total of 187 patients with chronic obstructive pulmonary disease (COPD) were treated in a rehabilitation program, initially as inpatients and then scheduled to continue 6 months or more in an outpatient clinic. The mean age was 61 (range, 28–76 years). Changes shown by participants in the outpatient program were compared to those shown by the nonparticipants. For both groups, the mortality rates were similar to published figures, and were strongly related to the levels of forced expiratory volume/sec (FEV1.0). The FEV1.0 declined significantly within one year in both groups. Psychologic test scores were unchanged. There was a sharp increase in unemployment. Although rehabilitative therapy must be continued, high priority should be given to early detection of COPD in patients who have airway obstruction but are otherwise asymptomatic. Possibly, at that stage, the elimination of cigarette smoking may slow the process.
Compression Injury of the Sciatic Nerve During a Prolonged Surgical Procedure in a Diabetic Patient†
Authors: Massey E. Wayne , Pleet A. Bernard
Published: April 2015

Patients with diabetes mellitus and an underlying mixed axonal and demyelinating polyneuropathy are particularly prone to compression neuropathies with consequent axonal degeneration and a poor prognosis for recovery. This hazard should be taken into account whenever a prolonged surgical procedure is contemplated. An illustrative case is presented.
Bacterial Pneumonia in the Elderly
Authors: Ebright J. R. , Rytel M. W.
Published: April 2015

A retrospective study was made of patients having community‐acquired pneumonia and treated at a large municipal hospital in 1973. Patients from nursing homes or other paramedical facilities were excluded. The incidence of Gram‐negative bacillary pneumonia was significantly higher in elderly patients compared to two younger groups, and mortality from this type of pneumonia was higher than from pneumococcal or staphylococcal types or from pneumonia of unknown cause. Recommendations are made for the initial treatment of elderly patients with community‐acquired pneumonia.
A System for Rating the Severity of Senility
Authors: Berger Eugene Y.
Published: April 2015

Although the development of senility in members of the aging population is not invariable or predictable at a specific age, the incidence is high and presents a constant problem for those responsible for the care of this group. A simple classification (Classes I‐VI) is suggested to describe the severity of senility. The crucial dividing line in the estimation of severity lies at mid‐point on the scale, i.e., between Clases III and IV. Class III (direction) represents patients who can accomplish activities if told what to do, and Class IV (assistance) represents patients who need physical help for the activities of daily living. On either side are Classes I and II (minor manifestations) versus Classes V and VI (ambulatory or bedridden patients, unable to communicate appropriately). The severity is estimated in terms of the needs of the patient.
Influenza: Epidemiology, Etiology, Immunization and Management†
Authors: Seneca Harry
Published: April 2015

Influenza, an acute contagious respiratory infection caused by orthomyxoviruses A, B, and C, occurs in local outbreaks, epidemics and pandemics. Differences in the morphology and antigen patterns for these viruses account for the differences in virulence and immunity. Influenza A is virulent, B is mild, and C is nonvirulent. Swine influenza virus may spread from swine to man (recycling of human A virus), causing epidemics and pandemics. The 1976–77 influenza vaccination program involved swine virus, and was associated with 321 cases of Guillain‐Barré syndrome and a mortality of 5 percent. Subsequent yearly programs with other types of vaccine are described. Dosages vary according to the age of the vaccinee. Those who need vaccination include persons over 65 years of age, patients with heart/lung, liver/lung or metabolic diseases, severe anemia, or a compromised antigenic system. Side effects include local reaction, fever, an allergic reaction (due to egg protein), and the Guillain‐Barré syndrome (only with swine virus vaccine). In general, influenza vaccine is safe and confers 60–85 percent protection. Since immunity lasts only about a year, annual vaccination with recently isolated virus vaccine is recommended. Amantadine seems effective therapeutically and prophylactically for clinical influenza A infection.
The Cellular Basis of Impaired T Lymphocyte Functions in the Elderly
Authors: Abe Tohru , Morimoto Chikao , Toguchi Takashi , Kiyotaki Masaya , Homma Mitsuo
Published: April 2015

Immunologic changes associated with aging were studied by various immunologic tests in 24 aged persons (age range, 76–83) and 25 young persons (age range, 20–40). The responses to phytohemagglutinin (PHA) and concanavalin A (Con A) were depressed in the aged subjects compared to the young ones (p < 0.05), whereas the responses to pokeweed mitogen (PWM) were similar. The activity of adherent and non‐adherent cells was assessed in various combinations. The adherent cells of aged persons were indistinguishable from those of young persons in their ability to response to Con A. Lymphocytes from the aged synthesized larger in vitro amounts of immunoglobulin than did lymphocytes from the young, when stimulated with PWM. Con A‐stimulated T lymphocytes derived from aged subjects showed a variable loss of suppressor activity. The mixed lymphocyte culture reaction with mitomycin‐treated allogeneic and autologous cells was also impaired in aged subjects. Such an impaired response in the aged is related to higher incidences of malignant lesions and auto‐antibodies.
Effect of Age on Glucose Utilization and Responsiveness to Insulin in Forearm Muscle†
Authors: Kalant Norman , Leibovici Dalila , Leibovici Theodore , Fukushima Naoki
Published: April 2015

To determine the effect of age on responsiveness to insulin, 34 healthy subjects (age range, 22–73 years) were studied. A glucose‐clamp technique was used to obtain a range of values for steady‐state arterial glucose and arterial insulin concentrations; total body glucose utilization was estimated from the rate of glucose infusion needed to maintain the steady state; and the uptake of glucose and insulin by forearm muscle was determined by a forearm perfusion procedure. The results were examined by multiple regression analyses. The rate of glucose utilization by the whole body as well as by forearm muscle was dependent upon the insulin concentration. Age had no apparent effect on body glucose utilization, the uptake of glucose or insulin by muscle, or the steady‐state insulin concentration in response to hyperglycemia. It is concluded that the abnormal glucose tolerance commonly associated with increased age is not due to a decrease in either insulin secretion or insulin stimulation of glucose uptake.
Community‐Acquired Bacteremia in the Elderly: Analysis of One Hundred Consecutive Episodes
Authors: Esposito Anthony L. , Gleckman Richard A. , Cram Sheila , Crowley Monique , McCabe Fannie , Drapkin Mark S.
Published: April 2015

A retrospective analysis was made of the records of 100 consecutive geriatric patients with community‐acquired bacteremia, admitted to a suburban hospital. The most frequently identified tissue sources for these bacteremias were the urinary tract (34 percent), biliary tract (20 percent), and lungs (13 percent). In 11 percent of the patients, the tissue focus was not established. E. coli, Klebsiella species and Streptococcus pneumoniae were the most common organisms isolated, and they contributed to 73 percent of the bacteremias. Of the 100 patients, 26 succumbed to the infection. Clinical manifestations unique to the geriatric patient are described.
Attitudes Toward the Geriatric Patient Among Family Practice Residents†
Authors: Maxwell Alan J. , Sullivan Nicole
Published: April 2015

For the Family Practitioner, elderly patients are a highly significant group. In the past, some health professionals have expressed negative attitudes toward the elderly. Thus a need exists to study specific factors that may influence a Family Practice resident's willingness to treat older patients. A Likert‐type questionnaire was developed that utilized the Thurstone‐Likert discrimination technique. Five categories were chosen for study: general attitudes, cost effectiveness, time and energy, therapeutic potential, and educational preparation. Responses of 150 Family Practice residents were then analyzed. The attitudes of the residents were significantly positive in all categories except Educational Preparation. Noteworthy was the finding that the attitudes improved from the first year through the third year of residency. This is the first medical specialty group to demonstrate such a trend. Certain negative attitudes observed in the Educational Preparation category re‐emphasize the need for training programs to improve professional geriatric instruction.
The Dunedin Program, a Florida Geriatric Screening Process: Design and Initial Data
Authors: Hale William E. , Marks Ronald G. , Stewart Ronald B.
Published: April 2015

The Dunedin program was started in 1975 for the purpose of screening participants over the age of 65, for medical disorders. Data are collected on family history, past medical history, drug history, current symptoms and disorders, and numerous biochemical and physiologic factors. In the past four years, 4,363 participants have been evaluated and a large data base has been derived concerning the 65+ age group. It is hoped that data from this program will facilitate the future assessment, treatment and care of the elderly.
Comparison of Two Brief Tests of Organic Brain Impairment, the MSQ and the Short Portable MSQ
Authors: Fillenbaum Gerda G.
Published: April 2015

A rapid means of validly assessing the presence or absence of organic brain impairment among the elderly is valuable for clinicians whose practice includes geriatric patients. Two such measures are the Mental Status Questionnaire (MSQ) and the Short Portable Mental Status Questionnaire (SPMSQ). The similarity of content of these two 10‐item questionnaires has led to the suggestion that their capacity to identify organic impairment may be similar. The question was examined in this study. Data were obtained on 83 elderly community residents on whom the validity of the SPMSQ had been tested. In 29 the diagnosis was organic brain syndrome (OBS), and the other 54 were classified as non‐OBS. After making minor changes in the scoring of the SPMSQ to improve discriminability (omissions were scored as errors), the MSQ and the SPMSQ were found to be equivalent in discriminating power. Both questionnaires accurately identified almost all (96 percent) of the non‐OBS subjects but missed nearly half of the subjects with a diagnosis of OBS. Item analysis indicated that two items in the MSQ and three items in the SPMSQ could explain nearly as much variance as did the total set of items. Thus the capacities of these two scales to identify the presence of diagnosed OBS among elderly community residents appeared to be equivalent. If test brevity is desired, the questionnaires could be made still shorter, with little loss of effectiveness.
Dietary Patterns and Cancer of the Digestive Tract in Older Patients†
Authors: Hunter Kathleen , Linn Margaret W. , Harris Rachel
Published: April 2015

This study involved 97 male veterans (age range, 45–65) in four approximately equal groups, classified as follows: 1) colon or rectal cancer, 2) upper digestive‐tract cancers, 3) other cancers, and 4) additional controls (no cancer). Dietary histories of these cancer and noncancer inpatients were recorded to see whether or not consumption of particular substances could be predictive of cancer. The interactions of substances in combination such as sugar × fat, and alcohol × smoking, proved to be important predictors of cancer of the upper digestive tract. The degree of coffee consumption was a predictor of nondigestive‐tract cancer. However, colorectal cancer patients could not be distinguished from non‐cancer patients by the dietary variables examined.
Some Demographic and Diagnostic Characteristics of a Geriatric Population in a State Geriatric Facility
Authors: Stevick Charles P.
Published: April 2015

Data are presented on some of the chief characteristics of a sample of 276 patients (152 women and 124 men) in a long‐term state psychiatry facility, who had previously undergone intensive psychiatric treatment. For the women the average age was 81.6 years, and for the men 75.8 years. The women had slightly more schizophrenia, manic depressive illnesses and cerebrovascular syndromes. The men had distinctly more CNS syphilis and alcoholic dementia. Initially, patients with schizophrenia had been admitted at ages ranging from 15 to 99 years, and those with manic depressive illness at ages ranging from 20 to 70 years. For cerebrovascular syndromes, admissions were concentrated in the age range of 70–90 for women and 65–85 for men. For CNS syphilis, the admissions (for men) were concentrated in the age range of 50–70, and for alcoholic dementia in the age range of 60–80. Length of stay was extremely long for schizophrenic and manic depressive illness and relatively short for cerebrovascular syndromes. However, for the majority of the cerebrovascular patients, the length of stay was at least five years for the men and at least ten years for the women.
Hospital Treatment of Elderly Neuropsychiatric Patients. I. Initial Clinical and Administrative Experience with a New Teaching Ward
Authors: Ford Charles V. , Spar James E. , Davis Barbara , Liston Edward H.
Published: April 2015

Program planning and the initial experience of a new teaching ward for geriatric psychiatry are described. Elderly psychiatric patients, with diagnoses predominantly of depression and dementia, demonstrate more self‐centeredness and less group awareness than do younger patients. Ward staff members often experience frustration, sadness and anger in response to working with them. Major problems unique to a geriatric psychiatry service include the paucity of adequate resources for post‐discharge care and the necessity to obtain excellent medical‐surgical consultation and support.
Stroke Rehabilitation—Is Age a Determinant?†
Authors: Adler Mark K. , Brown Curtland C. , Acton Patricia
Published: April 2015

A retrospective survey was made of the average improvement, length of stay, and discharge placement of 180 stroke patients admitted to a rehabilitation hospital. The patients were divided into four age groups: under 55, 55–65, 66–75, and over 75. A grading system was used for evaluating the patient's ability in ambulation and self‐care. No significant differences were found among the four age groups. The patients were then divided into subgroups depending upon the admission functional score: 0–20, 21–40, 41–60, and over 60. In the subgroups, no statistically significant differences were apparent for the average improvement of patients under age 55 as compared to those over 75, except for those whose initial functional score was 21–40. In this subgroup, the average improvement for patients under age 55 was 26.4 points with a length of stay of 31.9 days, whereas for those over age 75 the average improvement was 15.5 points with a length of stay of 25.9 days. Thus, age per se did not seem to be a determinant factor in successful rehabilitation; rather, the poor showing of the oldest group for the 21–40 score in the sub‐set may have been due to premature discharge.
Rheumatoid Arthritis Masquerading as Polymyalgia Rheumatica: Report of Two Cases
Authors: Weinberger Kenneth A.
Published: April 2015

Polymyalgia rheumatica is a syndrome rather than a specific entity. The cases of two elderly patients are reported. These patients presented with typical polymyalgia rheumatica, but later were shown to have rheumatoid arthritis. Rheumatoid arthritis in the elderly may first masquerade as polymyalgia rheumatica.
Quantitative Clinicopathologic Study of Cerebral Amyloid Angiopathy
Authors: Kurucz Janos , Charbonneau Rene , Kurucz Anna , Ramsey Patricia
Published: April 2015

A rapid screening method is described for detecting amyloid angiopathy (AA) in the meningeal vessels with the use of thioflavin‐S and fluorescence microscopy. AA was found most frequently in the brains of patients in whom senile degeneration of the Alzheimer type was complicated by severe arteriosclerosis, vascular hyalinosis and multiple infarcts (73 percent). In 69 randomly drawn mental hospital patients over the age of 55, the degree of AA was significantly correlated with the degree of organic symptomatology (r = .417, p < .001). Multiple regression analysis, however, revealed that AA as a predictor of clinical symptoms was highly dependent upon another predictor, i.e., the quantity of senile plaques in the brain. In contrast, a highly significant and independent correlation was found between the clinical symptoms and AA in a control sample of 21 patients who had mental illnesses other than senile dementia (r = .683, p < .001). In these patients the plaque count was very low and arteriosclerosis was prevalent. Among the clinical symptoms, Affect Lability was consistently most highly correlated with AA, whereas Disorientation was most highly correlated with the quantity of plaques.
Intra‐Institutional Relocation: Measured Impact upon Geriatric Patients*
Authors: Haddad Lawrence B.
Published: April 2015

A study was designed to measure the impact of intra‐hospital relocation upon elderly patients transferred to intermediate, skilled nursing, or psychiatric care facilities. The subjects were 389 elderly residents of a psychiatric hospital. Their mean age was 76.2 years, and mean length of hospitalization 22.4 years. A before‐and‐after analysis was made of behavior rating scores, and the mortality rate was compared with baseline values. The findings indicated that, for this type of reorganization, no deterioration was evident in the measured behaviors, nor did the move cause sufficient stress to have a substantial impact on mortality. It was concluded that, contrary to numerous reports in the literature, the mass relocation of elderly patients for the purpose of delivering more appropriate treatment services does not necessarily have detrimental effects. Additional research is required to account for outcomes related to the interaction between more specific personal characteristics and environmental components.
Analysis of the 1980 Heat Wave in Memphis*
Authors: Applegate William B. , Runyan John W. , Brasfield Linda , Williams Mary Lynn , Konigsberg Charles , Fouche Cheryl
Published: April 2015

During the heat wave of 1980, average daily temperatures in Memphis first rose above the mean on June 25 and remained elevated for 26 consecutive days. In July 1980, 83 heat‐related deaths were recorded as compared to none in July 1979. Most of these deaths occurred in elderly, poor, black, inner‐city residents. There was a statistically significant increase in total mortality rates, deaths from natural causes, cardiovascular mortality rates, and the rate for persons dead on arrival. Virtually all the excess mortality was in persons over the age of 60. The rise in heat‐related emergency room visits occurred three days prior to the rise in heat‐related deaths. Local planning for future heat waves should focus on the inner‐city black elderly. Heat‐related deaths and emergency room visits should be reported to public health officials.
Hyperparathyroidism in the Elderly*
Authors: Fiatarone Maria A. , Steel Knight , Egdahl Richard H.
Published: April 2015

A survey was made of the records of 40 patients aged 60 or older who were operated on at Boston University Medical Center over a 10‐year period for suspected primary hyperparathyroidism. Mild or “asymptomatic” presentation was virtually the rule, with many patients having become accustomed to some degree of decreased well‐being. The findings were compared with those in other reviews of the clinical manifestations of hyperparathyroidism, in both general and elderly populations of patients. Issues of screening for mild or asymptomatic disease, especially among the elderly, are discussed.
The Adaptive Function of the Menopause: A Devil's Advocate Position
Authors: Alington‐Mackinnon Diane , Troll Lillian E.
Published: April 2015

The menopause may be adaptive, in that it minimizes exposure to endogenous estrogen. However, ageist and sexist assumptions have distorted society's perceptions so that the menopause has come to be viewed as a “deficiency disease,” best treated through the routine prescription of estrogen replacement therapy. Recent evidence suggests that menopausal discomfort has been exaggerated, and that most reported symptoms are not directly attributable to declining estrogen levels but to other biologic and social variables. A change in perspective might have the beneficial consequence of providing women with more effective, and probably safer, forms of therapeutic intervention.
Urinary‐Tract Infections: Etiology, Microbiology, Pathophysiology, Diagnosis and Management
Authors: Seneca Harry
Published: April 2015

The increased incidence of urinary‐tract infections (UTI) may be due to prolonged human longevity, increased drug resistance of pathogens, poor resistance of the urothelium, and the existence of bacterial L forms. About 95 percent of recurrent infections are re‐infections. The most common uropathogen is Escherichia coli, and the most virulent is Pseudomonas. UTI may be manifested as: a) asymptomatic bacteriuria, b) acute uncomplicated infection, c) acute complicated infection, or d) recurrent infection. Recurrent infections usually are refractory to treatment, and are caused by a pathogen different from the original one. Upper‐tract (kidney) infections are difficult to cure, whereas bladder infections respond favorably. Prostatitis also responds poorly because effective drug levels are difficult to attain in prostatic tissue. Results of the antibody‐coated bacteria test (ACB) and the bladder‐washout test are helpful in locating the site of infection. Detailed outlines concerning diagnosis, management, chemotherapy and prophylaxis provide data on various types of infection and the effects of specific antimicrobial agents and other drugs at different sites in the urinary tract. A current plan for short‐course prophylaxis does not fulfill expectations.
The Future for the Elderly*
Authors: ARIE TOM
Published: April 2015

This tentative look into the future for the elderly covers such aspects as population statistics, the unique role of Medicine in contributing to the quality of life, the problems engendered by dementia patients and the “staff factor” involved in their care. The development of personality in the aged is stressed. Being attractive to others in the time of disability and old age is a valuable asset. There is great need for education of the public about the elderly.
Ethical Considerations in Critical and Terminal Illness in the Elderly*
Authors: LEVENSON STEVEN A. , LIST NOEL D. , ZAW‐WIN BO
Published: April 2015

In a Baltimore geriatric center and hospital, a program was developed to individualize the treatment of critically and terminally ill patients. Part of this program was an effort to involve the patients themselves in the discussion of their personal wishes, and the provision of a set of guidelines for staff members to help them individualize the care of the patients. Some of the practical problems involved in the application of these ethical ideals are discussed. Merely implementing the protocol helped staff members to become more aware of these complex questions. Physicians should deal forthrightly with “right‐to‐die” and associated issues. The decision‐making should remain in medical hands, and out of the courts and legislatures.
Treatment Results at a Multi‐Specialty Clinic for the Impaired Elderly and Their Families*
Authors: REIFLER BURTON V. , LARSON ERIC , COX GARY , FEATHERSTONE HARVEY
Published: April 2015

Geriatric and Family Services at the University of Washington provides a comprehensive evaluation and treatment program for the impaired elderly, and also offers support, counseling and practical advice for their families. Although most of the 76 patients in this first‐year study had cognitive impairment, about one‐fourth of them showed unequivocal motor, cognitive and/or affective improvement with treatment for previously undetected illnesses. The rating of “unequivocal improvement” required objective data, as well as corroboration by the patient and family. These therapeutic gains and the increased public interest led to expansion of the program.
Subcutaneous Infusions in the Elderly
Authors: SCHEN RAFAEL J. , SINGER‐EDELSTEIN MAIA
Published: April 2015

1,850 subcutaneous infusions were given to 270 elderly patients (average age, 82) in a hospital geriatric department and in two nursing homes. The side effects were few and not serious. In 4 patients there was anasarca of the gluteal and genital regions but this disappeared promptly after giving diuretics. In a case of disseminated intravascular coagulation, ecchymoses appeared in the thighs. Sepsis, shock, tissue necrosis and other dangerous side effects mentioned in textbooks were not observed. The method is acceptable to most elderly patients and causes less discomfort than does the intravenous method. Since the infusion lasts only 2 to 4 hours, it enables the patient to be out of bed most of the day. Infusion by the subcutaneous route can be safely administered by trained nurses in institutions without a resident medical staff. It seems to be the method of choice for giving fluid supplements to elderly patients in nonemergency situations.
Plasma Aldosterone Response to Angiotensin II in Sodium‐Restricted Elderly Subjects with Essential Hypertension
Authors: MORIMOTO SHINPEI , UCHIDA KENZO , MIYAMOTO MASAJI , KIGOSHI TOSHIKAZU , MORISE TOSHIO , TAKIMOTO HIROAKI , TAKEDA RYOYU
Published: April 2015

The plasma aldosterone (PA) response to sodium restriction (25 mEq daily for 4 days) and to graded infusions of angiotensin II (AH, 2, 4 and 8 ng/kg/min each for 30 min) during a low‐sodium intake were studied in 15 elderly subjects with mild essential hypertension versus 10 elderly normotensive subjects. The PA reponse to sodium restriction relative to changes in plasma renin activity (PRA) was estimated by the ratio of PA increment to PRA increment after sodium restriction (ΔPA/ΔPRA). The PA response to graded AII infusions was determined by the increment of PA above the basal level after each dose of AII. In 10 of the 15 elderly hypertensive subjects whose PRAs responded normally to sodium restriction, the ΔPA/ΔPRA ratios and PA increments during the graded AII infusions were similar to those in the elderly normotensive subjects. However, in the remaining 5 elderly hypertensive subjects whose PRAs responded subnormally to sodium restriction, the ΔPA/ΔPRA ratios were high and the PA increments greater during the graded AII infusions. The increments of mean blood pressure during the graded AII infusions were similar in the foregoing 10 of 15 hypertensive subjects, and significantly greater during the AH infusion rates of 4 and 8 ng/kg/min in the remaining 5 hypertensive subjects when compared with those in the normotensive subjects. Apparently some elderly subjects with essential hypertension, whose PRAs respond subnormally to sodium restriction, have an abnormally enhanced adrenal responsiveness to AII under the condition of low‐sodium intake.
Detrimental Incidents, Including Falls, in an Elderly Institutional Population
Authors: BERRY GLENICE , FISHER RORY H. , LANG SANDRA
Published: April 2015

In a Canadian geriatric hospital, the report forms on the 2,177 untoward incidents occurring during the 1976–78 period were analyzed. The incident and fall rates were respectively 51.1 and 42.7/10,000 patient‐days. Falls were the most common incident (82.9 percent). Of the patients who fell, 40.4 percent were over the age of 80 and another 27.5 percent were in the 71–80 age group. The majority fell more than once. Most falls occurred during the waking activity hours, and many were associated with the changing of position or posture, notably in the course of using a wheelchair. Alcohol was a factor in 4.2 percent of the incidents. Nevertheless, the rates for mortality and serious morbidity were low. Patients' rooms and toilets should receive extra surveillance, and the caretaker staff should exercise special care in the use of wheelchairs and assistive devices. More attention should be given to recording cases of postural hypotension, cardiac arrhythmias or drug side effects.
Synchronous Dual Primary Lung Carcinomas
Authors: SHANKAR PATIL S.
Published: April 2015

Synchronous dual primary lung carcinomas were found in 8 of 482 patients with lung cancer, an incidence of 1.6 percent. Of the 8 cases, 7 were unilateral and one bilateral. Three showed dissimilar histologic patterns occurring in combinations of squamous‐cell carcinoma and adenocarcinoma. In 5 cases, two separate tumors were noted with identical histologic patterns in combinations of squamous‐cell, giant‐cell, large‐cell, adeno‐. and undifferentiated carcinoma. The patients were heavy smokers and this possibly may have been a factor in the development of carcinoma at more than one site.
Physical and Mental Health Symptoms of Older People: Who Do They Tell?*
Authors: BRODY ELAINE M. , KLEBAN MORTON H.
Published: April 2015

ABSTRACT: A research study was designed to develop information about the day‐to‐day symptoms of older persons that often are not reported to professionals. As one aspect of the research, the subjects (N = 132) were asked: 1) if they had had any of a predetermined list of 20 symptoms during the previous month; 2) to whom did they report these symptoms; and 3) if no one had been told, what was the reason for not reporting. About half of the subjects had experienced difficulty in sleeping, tiredness, nervousness, feeling blue, unsteadiness on feet, and forgetfulness. A slight majority told someone (a professional, family member, or friend) about their symptoms, but a large proportion did not tell anyone. Most symptoms (56 percent) were not reported to health professionals. When another person was told, usually the recipient of the information was as likely to be a family member or friend as a professional. Reasons for not telling anyone included: the symptom was “no big deal”; “nobody cares”; “nothing can be done about it”; and “don't want to bother people.” The data are discussed in terms of the implications for health education of older people and family members, and for the attitudes and behaviors of health professionals.
Sliding Hiatal Hernia in the Elderly: A Clinical Entity
Authors: NANO MARIO , FERRARA LUIGI , CAMANDONA MICHELE
Published: April 2015

ABSTRACT: Sliding hiatal hernia occurs in the elderly with a symptom complex which differs from that seen in younger persons. A comparison of the symptoms of this disease in 66 older patients with the symptoms in 154 younger patients revealed four categories in the elderly: digestive, anemic, anginal, and pseudoneoplastic. Of these, the digestive‐tract abnormality, even though the most common, was the least characteristic and was caused by the associated pathologic lesions rather than by the hiatal hernia itself.
Diuretics and the Institutional Elderly: A Case against Routine Potassium Prescribing
Authors: HENSCHKE PHILIP J. , SPENCE J. DAVID , CAPE RONALD D. T.
Published: April 2015

ABSTRACT: In 14 elderly male residents of a veterans' care complex who were receiving diuretic therapy for cardiac failure, oral potassium (K) supplements were withdrawn. Plasma and erythrocyte K levels were measured immediately before and six weeks after withdrawal of the supplements (38 mEq K daily). The controls comprised 19 elderly residents without disease and not taking drugs likely to influence K status. Study subjects and controls were receiving the same diet (average daily K content 100 mEq). After withdrawal of K supplements, the mean plasma K level fell significantly but the mean erythrocyte K level remained unchanged and did not differ from the control values. For a further six weeks after the withdrawal period, 7 subjects were treated with Aldactazide (diuretic hydrochlorothiazide plus K‐sparing spironolactone). The plasma K level increased significantly but the erythrocyte K level remained unchanged. It was concluded that, in this setting, diuretic‐induced hypokalemia is not necessarily accompanied by intracellular K depletion and that routine prophylaxis with K supplements or K‐sparing agents is unnecessary and not without risk. Such therapy should be reserved for patients considered at special risk of K depletion because of known poor dietary intake, advanced liver disease, secondary hyperaldosteronism with renovascular hypertension, gastrointestinal losses, or nondiuretic medication known to affect K status adversely.
Hypernatremia in the Elderly: Relation to Infection and Mortality
Authors: MAHOWALD JOHN M. , HIMMELSTEIN DAVID U.
Published: April 2015

ABSTRACT: The records of 23 elderly patients admitted to a county hospital with dehydration and hypernatremia were reviewed. One of these patients had the highest serum sodium level (202 mEq/L) reported in an adult. The overall mortality of 48 percent was not related to the degree of hypernatremia. However, two‐thirds of the 17 patients with acute bacterial infections died, whereas all 5 noninfected patients survived. Infection was not always apparent at the time of admission to the hospital. It is proposed that early and appropriate antibiotic therapy may reduce the high mortality associated with hypernatremia in the elderly.
Osteochondral Graft in the Treatment of Osteonecrosis of the Femoral Condyle
Authors: GANEL A. , ISRAELI A. , HOROSZOWSKI H. , FARINE I.
Published: April 2015

ABSTRACT: A 65‐year‐old woman with spontaneous osteonecrosis of the medial femoral condyle of the left knee was treated by a fresh cadaveric osteochondral bone graft. The latest follow‐up examination at 2.5 years demonstrated good functional results, as well as radiographic evidence of satisfactory consolidation with no aseptic necrosis or osteoarthritis.
Hypertension in the Elderly: The Time Has Come to Treat
Authors: RADIN ALAN M. , BLACK HENRY R.
Published: April 2015

ABSTRACT:Both pure systolic, and systolic plus diastolic hypertension are risk factors for cerebrovascular and cardiovascular disease in patients over 65 years old, but the efficacy of antihypertensive therapy in preventing the complications of hypertension in the elderly has been questioned. The risks associated with such therapy seem to have been overemphasized. Although the evidence is incomplete, elderly patients should be treated when the systolic blood pressure exceeds 160 mm Hg or the diastolic pressure exceeds 95 mm Hg, or both. A revised stepped‐care approach, with use of vasodilating agents as the Step‐2 drugs, is proposed.
Evaluation of the Clinical Use of Serum Digoxin Radioimmunoassays
Authors: VOLPONE M. TERESA , McLEOD DON C.
Published: April 2015

ABSTRACT: Of 2,586 consecutive patients admitted to a private general teaching hospital, 370 (14 percent) received digoxin therapy. Serum digoxin assays were performed on 261 of these 370 subjects. In a representative sample of 97 patients, 61 attending physicians were responsible for their care. The mean and median age of the patients was 70 years (range, 39–96 years), and one‐quarter of them had a significant degree of renal impairment. Sixty‐one percent of the patients were being treated for congestive heart failure (CHF), and the remainder for atrial fibrillation with or without CHF. Overall, 67 percent of the serum digoxin assays were judged to be appropriate, particularly those requested for evaluation of possible digitalis toxicity or the dosage in renal impairment, but only 43 percent of the assays used to assess maintenance therapy or the patient's compliance were deemed appropriate. A significant difference was found in the percentage of appropriate assays rated useful by the physicians, as compared to the percentage of inappropriate assays. Inappropriate serum digoxin assays cost about $30,000 annually in this 680‐bed hospital. Stricter criteria for admission assays would eliminate much of this excessive usage.
The “Elephant Man” of Cambridge. A Case Report of Neurofibromatosis
Authors: RAI G. S. , CONI N. K.
Published: April 2015

The case is presented of a 65‐year‐old man with neurofibromatosis manifesting facial and skeletal features resembling those of the “elephant man” described by Sir Frederick Treves. Autopsy revealed not only a pheochromocytoma (a common accompaniment of neurofibromatosis), but an enlarged infarcted spleen and a subphrenic abscess. These findings have not been described previously in a patient with neurofibromatosis.