bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurotransmitter Precursor Amino Acids in the Treatment of Multi‐Infarct Dementia and Alzheimer's Disease†
Authors: Meyer John Stirling , Welch K. M. A. , Deshmukh V. D. , Perez F. I. , Jacob R. H. , Haufrect D. B. , Mathew N. T. , Morrell R. M.
Published: April 2015

Ten patients with severe dementia due to Alzheimer's disease (AD) or multi‐infarct dementia (MID) or both, were treated with the precursor amino acids of the neurotransmitters serotonin and dopamine. The precursor amino acids (PAA) were given orally in a preparation that included tyrosine (4 gm daily) and 5‐hydroxytryptophan (5‐HTP) (800 mg daily), plus carbidopa (100 mg daily) as an aromatic amino‐acid decarboxylase inhibitor. Diagnosis was established by an electroencephalogram, brain scan, computerized axial tomographic scan, and in one case by necropsy findings. Serial clinical evaluations and measurements of neuropsychologic function were performed. Levels of homovanillic acid (HVA) and 5‐hydroxyindoleacetic acid (5‐HIAA) were determined before and after administration of probenecid. Side effects of the PAA therapy were diarrhea, drowsiness, nausea, vomiting and agitation, all of which were controlled by reducing the dosage. One patient with MID and one with AD + MID showed clinical and psychologic improvement, but the others did not improve. Analysis of the cerebrospinal fluid for HVA and 5‐HIAA before and after the probenecid test indicated some improvement in the metabolic turnover of these acid metabolites of serotonin and dopamine after administration of their precursor amino acids.
Idiopathic Hemochromatosis: Case Report of a Patient Presenting with Neurologic Symptoms
Authors: Sinclair William P. , Afrooz Nader
Published: April 2015

Idiopathic hemochromatosis is an iron‐storage disease more common in men than in women. It is characterized clinically by diabetes mellitus, cirrhosis of the liver, pigmentation of the skin and cardiac failure. The diagnosis may be overlooked when the presenting symptoms do not follow the pattern. A case is reported which was diagnosed after an onset that featured neurologic symptoms.
Physical Fitness and Age, with Emphasis on Cardiovascular Function in the Elderly†
Authors: Hodgson J. L. , Buskirk E. R.
Published: April 2015

Progressive decline in the functional capacity of the cardiovascular system with age is a widely accepted concept. A survey of the literature of cross‐sectional studies of men aged 20 to 60 clearly indicates a decline in aerobic capacity (O2max) of about 0.45 ml · kg−1· min−1· yr−1regardless of activity level. Data from longitudinal studies of sedentary men suggest that the rate of decline inO2max is more rapid than indicated from the cross‐sectional studies which include subjects who are physically active. For sedentary women the decline inO2max with age seems to be less than that reported for men (0.30 ml · kg−1· min−1· yr−1). Excessive fatness in young men does not appear to compromise their cardiovascular function but it does limit their ability to transport their body weight over distance and reduces their heat tolerance.O2max per kg of total weight is, however, only 10 percent less than that for normal‐weight men at age 60. Of the obese subjects studied (N = 4) over the age of 40,O2max per kg fat‐free body weight was the same as for normal‐weight men (N = 17). The effect of exercise on improvement of aerobic capacity in the elderly and the optimum frequency, intensity and duration of exercise programs at specific ages requires additional investigation. The effect of regular exercise on reducing the frequency of premature ventricular contractions and on improving heat tolerance also requires clarification.
Free Radical Theory of Aging: Effect of Free‐Radical‐Reaction Inhibitors on the Immune Response†
Authors: Harman Denham , Heidrick Margaret L. , Eddy Dennis E.
Published: April 2015

Immune responses decline with age. Endogenous free radical reactions, implicated in aging, may contribute to this decline. To evaluate this possibility, either α‐tocopherol acetate (vitamin E) or a quinoline derivative (Santoquin), both free‐radical‐reaction inhibitors, were added to the diet of C3HeB/FeJ female mice from age 6 weeks through 88 weeks at a level of 0.25 percent by weight of the diet. Both these antioxidants enhanced immune responses up to age 88 weeks, and probably also for the remainder of the lifespan; the experiment was stopped at age 88 weeks, as all the mice had been used for assay. Vitamin E had a greater effect than Santoquin on humoral responses, whereas cell‐mediated responses were enhanced more by Santoquin. Prompted by the foregoing study, levamisole or one of a number of different free radical inhibitors was added to the diet of groups of young mice for one month, after which the humoral response of spleen cells were determined. The five free radical inhibitors found to be as effective as levamisole were: 2‐mercaptoethanol, butylated hydroxytoluene, 2‐mercaptoethylamine, Santoquin, and sodium hypophosphite. These studies suggest, but do not prove, that some endogenous free radical reactions contribute to the decline of the immune response with age. This decline can be ameliorated by adding inhibitors of free radical reactions to the diet.
Left Fascicular Hemiblocks in the Elderly
Authors: Tammaro Aldo E. , Forin Giorgio
Published: April 2015

A three‐year follow‐up study was made of 45 elderly subjects with left anterior hemiblock, either alone or associated with right bundle‐branch block. In the LAH + RBBB group, there was a higher mortality rate and frequent evolution toward complete A‐V block. The prognostic significance of left fascicular hemiblocks is discussed.
Depression in the Aged: Theoretical Concepts†
Authors: Grauer H.
Published: April 2015

The etiology of depression in the aged is discussed from the viewpoint of biologic, psychodynamic, genetic and sociocultural concepts. The chronic neurotic depression of the aged seems to differ from that of younger age groups. The understanding of geriatric depression requires a multidisciplinary approach.
Precordialgia As a Manifestation of Vertebrobasilar Insufficiency
Authors: Guido Ernesto M. , Rivera Victor M.
Published: April 2015

In 6 patients with vertebrobasilar insufficiency (VBI), precordialgia and autonomic‐nervous‐system manifestations such as diaphoresis and tachycardia were associated with the symptoms of VBI. Investigation ruled out cardiac and gastrointestinal causes. Possible mechanisms are discussed on the basis of intermittent ischemia of the central autonomic centers supplied by the posterior circulation.
Fractures of the Radial Head in the Geriatric Patient: Case Report†
Authors: Pick Robert Y.
Published: April 2015

Fractures of the radial head and neck occur frequently. Although reports in the literature advocate both operative and nonoperative modes of treatment, the trend is toward the nonoperative approach. In many instances this yields results that are comparable, if not superior, to those obtained by surgical intervention—as in the 62‐year‐old man who is the subject of the case report.
The Systemic Use of Procaine in the Treatment of the Elderly: A Review†
Authors: Ostfeld Adrian , Smith Cedric M. , Stotsky Bernard A.
Published: April 2015

This article is a review and evaluation of the world literature on the systemic use of procaine in the treatment of the aging process and the common chronic diseases of later life. Included are data from 285 articles and books, describing treatment in more than 100,000 patients in the past 25 years. Except for a possible antidepressant effect, there is no convincing evidence that procaine (or Gerovital, of which procaine is the major component) has any value in the treatment of disease in older patients. If procaine has an antidepressant effect, there is some likelihood that this accounts for the reports of decreased complaints referable to the musculoskeletal, cardiovascular, endocrine, sexual, gastrointestinal and respiratory systems.
The Biologic Aspects of Cancer of the Breast: A Challenge*
Authors: Copeland Murray M.
Published: April 2015

The crude incidence rate for cancer of the breast far exceeds that for any other type of cancer found in either sex. In women it is nearly twice the rate for the next most common malignant disease found in both men and women. The percentage of patients with localized disease has gradually increased but now is approaching a plateau. There is a definite increase in the incidence of breast cancer in premenopausal women which counterbalances the better results with reference to age‐specific death rates. The absolute survival rate indicates that mortality rates continue to be “above normal” for a considerable period beyond the five‐year point. It is important, therefore, to study the challenge which confronts us, to keep in mind the natural history of the disease, to review the known high‐risk factors and tumor‐host relationships, and to evaluate continually all available diagnostic and therapeutic measures. These measures include those not used in routine practice, and especially those involving new concepts.
Counselling the Elderly on Nutrition in a Community Health Care System
Authors: Rae Jessie , Burke Anne Louise
Published: April 2015

A study was made of the effects of community nutrition services on 234 noninstitutional elderly aged 65 or older. Many of the problems were related to overweight and longstanding inappropriate food habits. The results indicated that counselling can stimulate an increased awareness of nutrition and improvement in the knowledge of nutrition and food selection. These elderly persons seemed to have a definite desire to achieve good health and were receptive to the nutritionist's recommendations. However, economic and physical limitations often influenced their ability to adhere to the recommendations. In counselling the elderly, the nutritionist should be able to make a quick assessment of the elderly person's physical capabilities.
Suicide Pact in a Depressed Elderly Couple: Case Report
Authors: Mehta Dinesh , Mathew Poyanil , Mehta Shobhana
Published: April 2015

An elderly depressed couple with multiple physical problems decided that death was preferable to their present lifestyle, and made a suicide pact. At the last minute the wife felt unable to go through with it and the couple entered a psychiatric hospital. During their 3‐week stay they were treated appropriately with amitriptyline and psychotherapy. Since discharge they have been followed closely for two years. Some psycho‐ and socio‐dynamic and therapeutic aspects are discussed.
Nutritional Hypovitaminosis‐D and the Genesis of Osteomalacia in the Elderly
Authors: ANWAR MASUD
Published: April 2015

A review is presented of the genesis of osteomalacia due to dietary lack of vitamin D in the elderly in the United Kingdom. Subjects at high risk are identified and the diagnostic difficulties discussed. The importance of dietary vitamin D and exposure to sunlight in relation to vitamin status is stressed. The role of vitamin D in calcium metabolism is now much more clearly defined; the final active form of the vitamin is 1,25‐dihydroxy‐vitamin D, which acts like a hormone after the vitamin molecule has undergone two chemical modifications in the liver and kidney. A correlation between lack of vitamin D and femoral neck fractures has been established. Six illustrative cases of osteomalacia in the elderly due to dietary lack of vitamin D are reported.
Renin and the Juxtaglomerular Apparatus in Diabetic Nephropathy
Authors: NAKAMURA RYUICHI , SARUTA TAKAO , YAMAGAMI KEIICHI , SAITO IKUO , KONDO KAZUOKI , MATSUKI SHUN
Published: April 2015

In order to study the role of the renin‐angiotensin system in patients with diabetic nephropathy, renin release and the juxtaglomerular apparatus were studied in 17 diabetic patients with proteinuria and in 23 without proteinuria; 8 normal subjects were used for controls. Despite hypertension and marked arteriosclerosis, plasma renin activity (supine posture) was normal; however, the renin response to salt restriction and upright posture was less in the diabetic patients with proteinuria than in the controls. Renal renin content, determined at autopsy, was also normal. Examination of the juxtaglomerular apparatus in the diabetic patients with proteinuria revealed hyalinization of the afferent and efferent arterioles in most of the glomeruli and various degrees of destruction of the juxtaglomerular cells. The findings suggest that renin production is not increased in diabetic patients with proteinuria plus marked vascular damage, and that the renin‐angiotensin system in patients with diabetic nephropathy apparently does not play an important role in the exacerbation of hypertension or the degree of vascular damage.
Optimism in the Management of Hip Fracture in Elderly Patients
Authors: MIKHAIL S. F. , SONN M. , LAWTON A. H.
Published: April 2015

The present generation of those past age 70 grew up with the idea that a fractured hip meant “the beginning of the end” for the elderly. The results reported here on the treatment of 50 consecutive patients over 70 years of age who had sustained a fractured hip indicate that in this situation the orthopedic surgeon can be an important partner in geriatric medicine. He can improve the functioning and health of this special group of elderly trauma victims through reassuring them that the fracture usually can be successfully treated without undue risk to life. The present improved state of the art of anesthesiology, surgery, and pre‐ and postoperative medical care makes the surgical risk tolerable, and helps to prevent many of the complications that used to occur in elderly patients confined to bed for long periods following hip fracture.
Logical Bases for Action in Nutrition and Aging*
Authors: WATKIN DONALD M.
Published: April 2015

Logical bases (five of which are outlined) underlie action in nutrition and aging. First, nutrition, health, and aging form an integral triad affecting all. This basis has been applied to the conceptualization of the Nutrition Program for Older Americans (NPOA). Second, in North America, malnutrition is a sequitur of disease, whether physical, metabolic, emotional, or attitudinal. This basis is being applied by NPOA and other programs in an effort to cope with the pathologic conditions that bar proper nutrition. Third, since aging is a lifelong process, good nutrition and health practices must be applied throughout life. This basis will become effective only when the present image of the aged improves to the point that younger persons will strive for effective longevity. Fourth, changes in lifestyle to avoid risks have positive value. This basis requires professional and political leadership if it is to become widely adopted. Fifth, acute illnesses and accidents require immediate attention to nutritional and other factors if needless morbidity and mortality are to be avoided. This basis requires far more education of health professionals and lay persons to obviate such tragedies. All these bases are the infrastructure for other actions directed at improving the image of today's aged and thereby diminishing the fatalism of younger persons and augmenting their determination to adopt lifestyles compatible with long, active, happy and productive lives.
Individual Psychotherapy with the Depressed Elderly Outpatient: An Overview
Authors: WILLNER MARCIA
Published: April 2015

A review is presented of the status of geriatric psychotherapy with the depressed elderly community resident, over the past 20 years. Feelings of helplessness and hopelessness accompanying or following a significant loss are often chief features of the depressive syndrome in elderly persons who seek help. The experiences of those involved in treating this disorder in the elderly can be most rewarding to both therapist and patient.
Brain Function, Intellectual Impairment and Education in the Aged
Authors: Zarit Steven H. , Miller Nancy E. , Kahn Robert L.
Published: April 2015

In assessing behavioral problems of the elderly there is a need for procedures which reliably indicate the presence and extent of impaired brain function. In this study, the relation of two mental status measures [the Mental Status Questionnaire (MSQ) and the Face‐Hand test] to intellectual performance and education was evaluated. The sample consisted of 153 consecutive inpatients and outpatients referred to a gerontology clinic. Intellectual performance was assessed with 8 tests of learning and memory, such as Paired Associates and Babcock Story Recall. The findings indicate that positive ratings for impaired brain function on either mental status test were related to lower intellectual performance at each of three levels of education — grade school, high school, and college. Subjects with more education and mental status scores indicating mild impairment performed better on intellectual tests than did less educated persons with no brain dysfunction, but they showed significant deficits compared to other subjects with similar education and intact brain function. Larger intellectual deficits were found when the patient made more test errors and when both tests gave positive ratings. These results confirm the importance of the MSQ and Face‐Hand tests as screening devices for the intellectual deficits associated with impaired brain function in a clinically heterogeneous population.
Spectrum of Severity and Control of Diabetes Mellitus in Skilled Nursing Facilities*,†
Authors: ZIMMER JAMES G. , WILLIAMS T. FRANKLIN
Published: April 2015

ABSTRACT: A descriptive and quality assessment study was made of 359 elderly patients with a diagnosis of diabetes mellitus in 39 Skilled Nursing Facilities (SNF) in upstate New York. The diagnostic prevalence of diabetes was about 12 percent — similar to that in a National Health Survey of nursing homes, but higher than that reported for the non‐institutional elderly. Greater frequency and severity were observed among the females, but the median age for all the diabetic patients was about the same as that for the general SNF population. Several of the other disorders believed to be associated with diabetes were found to be of greater frequency in the SNF diabetic group, but some were not; also, inadequate control of diabetes was associated with some, but not all of these disorders. The severity of diabetes in this elderly SNF population with adult‐onset diabetes was usually mild, with a low frequency of complications and of poor control. Problems arose with respect to the ascertainment and recording of diagnostic and control data, most often related to the responsibilities of the attending physicians. There were also problems of uncertainty as to the cause‐and‐effect relationship between the control of blood glucose levels and treatment outcomes. The establishment of criteria and standards for medical care evaluation studies is discussed.
Fever of Unknown Origin in the Elderly
Authors: ESPOSITO ANTHONY L. , GLECKMAN RICHARD A.
Published: April 2015

ABSTRACT: An extensive literature survey was performed and hospital records were reviewed in order to identify cases of fever of undetermined origin in patients aged 65 or older. Analysis of the 111 cases discovered demonstrates a characteristic but not unique spectrum of underlying disorders. Potentially curable entities such as abdominal abscess, bacterial endocarditis, tuberculosis and giant‐cell arteritis account for more than half of the serious illnesses presenting with prolonged pyrexia in elderly subjects. A diagnostic approach to the management of the persistently febrile geriatric patient is discussed.
Fractures of the Hip: A Three‐Year Survey in One Hospital, Including Experience with the Pugh Nail Procedure
Authors: MALKIN SOL , FRANKENBURG FRANCES
Published: April 2015

ABSTRACT: Records were reviewed on 445 patients with fracture of the hip admitted to St. Paul's Hospital, Vancouver, Canada, during the period 1973–1975 inclusive. The epidemiologic factors were analyzed: age, sex, where and when the accident occurred, site of the fracture, the treatment procedure, length of time in hospital, complications, associated conditions, and final placement of the patient. Of the patients, 286 (64 percent) were more than 70 years of age. Among the 260 causal accidents in the patients' home living space or in the hospital, 35 involved toileting. The great majority of the fractured hips (330) were treated by open operation and internal fixation with the Pugh nail; the remainder were treated by conservative methods, various other devices, or arthroplasty. Within 30 days, 121 patients were discharged to their own homes and 68 to a major rehabilitation hospital. A total of 289 patients eventually returned to their own homes. The Pugh nail method of fixation permits early physiotherapy and early walking exercises, beginning within the first few days postoperatively. This largely accounts for the low complication rate, rapid achievement of functional status, and reduced hospital stay. Among the 445 patients there were 43 deaths, including 10 which occurred before operation could be undertaken.
Treatment of Hypertension in the Elderly with Pindolol and Clopamide
Authors: PERSSON I.
Published: April 2015

ABSTRACT: After a 2‐week washout period, 30 elderly hypertensive patients were treated with pindolol (a /3‐adrenergic blocker) for 3 weeks. In 13 patients the reduction in blood pressure was satisfactory and treatment with pindolol was continued for another 4 weeks. In 17 patients the subsequent treatment was supplemented with clopamide (a diuretic) for 4 weeks; in 6 the results were satisfactory. Side effects were few and mild.
Werner's Syndrome: Analysis of 15 Cases with a Review of the Japanese Literature*
Authors: GOTO M. , HORIUCHI Y. , TANIMOTO K. , ISHII T. , NAKASHIMA H.
Published: April 2015

ABSTRACT: Fifteen patients with Werner's syndrome were studied 12 males and 3 females, whose ages ranged from 17 to 59 years. Most of the previously reported clinical characteristics were confirmed, and an additional finding was the frequent occurrence of flat feet and hyperreflexia of the patellar and Achilles tendons. Also noted were an excessive urinary excretion of hyaluronic acid and a decrease in the T‐cell subpopulation. The significance of these findings is discussed.
Clinical Value of the London Psychogeriatric Rating Scale
Authors: HERSCH EDWIN L. , KRAL V. A. , PALMER R. BRUCE
Published: April 2015

ABSTRACT: The London Psychogeriatric Rating Scale (LPRS) was developed in answer to the demand for a reliable psychometric rating scale suited to a psychogeriatric population. All inpatients on a Psychogeriatric Unit (approximately 140 at any specific time) were rated with the LPRS every third month for an 18‐month period. The 4 components of the total score include a measure of mental status originally derived by factor analysis. Predictive validity has been established in terms of various clinically relevant areas including the following: a) ward placement; b) outcome (continued hospitalization, discharge, or death); c) diagnosis (by scoring levels and progress patterns across time); and d) ability of the patient to function in, or benefit from, a particular treatment program. The scale has been used successfully to assess a given patient's progress quantitatively and globally over a long period.
Cyclandelate in the Treatment of Senility: A Controlled Study
Authors: CAPOTE B. , PAKIKH N.
Published: April 2015

ABSTRACT: Elderly patients often manifest a variety of symptoms (e.g., depression, memory loss, irritability, hostility), categorized as “senility” or “senile dementia,” which are difficult to treat and represent a major therapeutic challenge to the geriatrician. This investigation was designed to assess, under double‐blind conditions, a drug often prescribed for these symptoms ‐ cyclandelate. In a 16‐week study, 58 elderly patients were randomly assigned to two groups and received either 1600 mg of cyclandelate daily or identical‐appearing placebo capsules. Initially, and every four weeks thereafter, the patients were examined for changes in vital signs and for adverse reactions; also, the Sandoz Clinical Assessment‐Geriatric (SCAG) Scale and the Nurses Observation Scale Inpatient Evaluation (NOSIE) were completed. At the final evaluation, a physician's global rating was obtained. Our data suggest that cyclandelate is a safe and moderately effective treatment for certain symptoms of senescence in carefully selected patients.
Second Heart Sound: A Phono‐Echocardiographic Correlation in 20 Cardiac Patients
Authors: PRAKASH RAVI
Published: April 2015

ABSTRACT: In 20 cardiac patients, a study was made of the relationship between the second heart sound (S2) recorded by phonocardiography and the motion of the aortic valve recorded by simultaneous echocardiography. Since the first component of S2 coincided with closure of the aortic valve in all 20 patients, it is concluded that the origin of the first component of S2 may be related to aortic valve closure.
Relative Genealogic Incidence of Certain “Civilization Diseases” in a Geriatric Population versus Pregeriatric Groups
Authors: ZDICHYNEC B. , STRANSKY P. , HARTMANN M. , HOLAS V. , KONRAD J. , HOGEN J. , SVATOS Z. , SABL J.
Published: April 2015

ABSTRACT: In a prevalence epidemiologic study conducted in a characteristic submontane area in North Bohemia, the genealogic incidence of myocardial infarction, sudden brain vascular episodes, and malignant tumors was studied in a representative sample of persons aged 70 to 105 years. The incidence was then compared with that in two other samples: 1) men under age 40 with a history of transmural myocardial infarction, and 2) both men and women aged 40–60 who had had a stroke. The statistical evaluation was performed according to accepted international criteria (WHO). A significantly lower genealogic incidence of myocardial infarction and sudden brain vascular episodes was found in the geriatric subjects (70–105 years old) who had symptoms of so‐called physiologic aging, as compared with the incidence in the younger subjects who had symptoms of so‐called pathologic aging. The difference was less clear‐cut with respect to the genealogic incidence of malignant tumors.
Interest in Geriatrics at a University Department of Medicine
Authors: JOHN ANDREW , STEEL KNIGHT
Published: April 2015

ABSTRACT: To estimate available resources for teaching geriatrics to medical students, a survey of the members of a university Department of Medicine was undertaken. Information was elicited in six areas: 1) personal data, 2) characteristics of each physician's clinical practice, 3) potential interest in a Division of Geriatrics, 4) the comparative levels of aggressiveness indicated in the management of an old patient versus a young one, 5) the attitude of physicians toward the elderly, and 6) a rough measure of knowledge of the demographic characteristics of the elderly. The results suggest that a significant number of faculty members of a university medical school would indeed be interested in teaching and research in the field of geriatrics.
Mortality of the Aged with Chronic Brain Syndrome: Further Observations in a Five‐Year Study
Authors: PECK ARTHUR , WOLLOCH LEON , RODSTEIN MANUEL
Published: April 2015

ABSTRACT: In order to pursue the question of excess mortality due to chronic brain syndrome (CBS), 330 residents of a home for the aged were independently evaluated prior to admission by psychiatrists and by general physicians. Five years later, their medical records were searched to determine: 1) age on admission, 2) diagnosis of CBS on admission, 3) physical status on admission, and 4) if death had occurred, the age at death and the cause of death. Women outnumbered men by 3:1. Subjects with CBS outnumbered those without CBS by 2:1. A previous mortality study on 145 aged subjects at the same institution provided an excellent frame of reference for this investigation. Among the men there was no difference between the mortality rates for those with CBS and those without. Among the women a statistically significant difference in mortality was found between those with CBS and those without. Women with CBS and a “poor” physical status had the highest mortality rate. Those who initially had CBS died significantly sooner even if their admission physical status had been “good.” Their mortality rate exceeded that for women with a “poor” physical status who did not have CBS. Bronchopneumonia caused death twice as often in subjects with CBS as in those without CBS, both among men and women. It is concluded that CBS per se is a significant factor in increasing mortality in the aged.
Prevention of Psychiatric Recidivism: A Model Service*
Authors: LEVENSON ALVIN J. , FELKINS BARBARA J.
Published: April 2015

This article describes the patient‐care activities of a medical school multidisciplinary section on geriatric psychiatry. The main treatment goal is the prevention of psychiatric recidivism. An index of this prevention is the re‐admission rate, since the risks of institutionalization and recidivism tend to rise with each successive admission. The Section reported a re‐admission rate of 4 percent for the first year of operation, a rate significantly less than that reported in the literature. The Section's achievement is predicated upon compliance with the requirements for optimal mental health care of the elderly. The protocol is presented in the hope that it may help others who wish to start such a service.
Insomnia in the Elderly: Treatment with Flurazepam Hydrochloride
Authors: FROST JAMES D. , DeLUCCHI MILTON R.
Published: April 2015

Under sleep‐laboratory control, the efficacy of flurazepam hydrochloride (15 mg) was evaluated in 6 women (age range, 67–82 years) with objectively verified insomnia. A 15‐night, single‐blind, crossover procedure was followed. Sleep records obtained during 3 placebo‐baseline nights, 7 consecutive flurazepam nights, and 3 placebo‐withdrawal nights were evaluated by means of electroencephalographic, electro‐oculographic, and electromyographic criteria. A statistically significant reduction in sleep latency and total awake time and a corresponding increase in total sleep time (P < 0.05) were demonstrated during the active drug period. No evidence of diminishing effectiveness was observed during the 7 days of drug administration. For the rapid‐eye‐movement (REM) stage, a significant decrease (P < 0.05) in mean REM percent was noted during the drug period despite an increase in mean absolute REM time. No REM rebound occurred upon drug withdrawal. There were no significant changes in mean percentages for stages 3 and 4 during the drug period and the withdrawal period. Adverse reactions were rare (chiefly some daytime drowsiness in 2 subjects).
Importance of a Regular Source of Medical Care Among the Elderly
Authors: KLEIMAN MICHAEL B.
Published: April 2015

In recent years health services researchers have become increasingly aware of the importance of a regular doctor to whom the patient usually goes when sick or in need of advice about health, as a means of providing a point of entry to needed medical care. For example, persons who have a regular source of care seem more likely to receive an annual physical examination, to experience continuity of care when needed, and to be satisfied with the care received. Yet, despite the importance of an established tie to a regular treatment source, evidence is scanty with respect to the aged. To address the issue, this study employs data from a national probability sample of 11,619 persons, of whom 1,506 were aged 65 or older. The findings indicate that several factors (e.g., sex, race, education, and community size) which traditionally have served as important indicators of the use of health services fail to emerge as strong determinants regarding the regular source of care among the aged. The consequences of these findings and implications for future research are discussed.
Mitral Valve Prolapse in the Elderly
Authors: Tresch Donald D. , Siegel Ronald , Keelan Michael H. , Gross Charles M. , Brooks Harold L.
Published: April 2015

This study included 40 patients over 60 years of age with echocardiographic findings of mitral valve prolapse (MVP). Most of these patients were unaware of any cardiac disorder until the time of echocardiography. In the majority, the clinical manifestations were benign, and the duration of symptoms variable. Congestive heart failure (CHF) was noted in 10 patients (25 percent) who were unaware of having any cardiac disorders until the onset of their symptoms. In 5 patients (4 with CHF and 1 with endocarditis), surgical replacement of the prolapsed mitral valve was necessary. Endocarditis was present in 4 patients (10 percent), none of whom had been instructed in the prophylactic use of antibiotics. The physician's awareness of mitral valve prolapse in the elderly patient is important, since the disorder may not be as benign in aged patients as in younger ones, and life‐threatening complications may occur.
Appropriateness of Vitamin and Mineral Prescription Orders for Residents of Health Related Facilities*
Authors: Sorensen Andrew A. , Sorensen Donna I. , Zimmer James G.
Published: April 2015

A study was made of the medical charts of 433 elderly patients admitted to four Health Related Facilities in upper New York State, to determine whether the respective prescription orders for vitamins and minerals were appropriate to the given diagnoses and, if not, to identify the variables correlated with inappropriateness. For 11.1 percent of the patients, vitamins or minerals were prescribed when there was no specific diagnostic indication, or they were not prescribed when the medical diagnosis indicated that they should have been. Women and Medicaid patients were more likely than men and self‐paying patients to be treated inappropriately with respect to vitamins and minerals, but the differences were not statistically significant.
Reduced Serum Albumin Concentration in the Elderly: A Report from the Boston Collaborative Drug Surveillance Program
Authors: GREENBLATT DAVID J.
Published: April 2015

ABSTRACT: The relation of serum albumin concentration to age was assessed in a series of hospitalized medical patients. Those with disease states (e.g., dysproteinemia, renal insufficiency, hepatic dysfunction, malnutrition) potentially associated with abnormal serum albumin levels were excluded, leaving a study population of 11,090 patients. The mean serum albumin concentration fell progressively with each decade of age, from 3.97 gm/100 ml in subjects aged less than 40, to 3.58 gm/100 ml in those aged 80 or older (F > 50.0, P < .001). The percentage of patients with a normal serum albumin level (4.0 gm/100 ml or higher) also decreased progressively with age, whereas the frequency of a low serum albumin level increased with age. Sex, primary diagnosis, blood urea nitrogen concentration, duration of hospitalization, and geographic location of the hospital did not influence the findings. The reduced serum albumin concentration in the elderly could contribute to age‐dependent changes in the clinical effects of certain albumin‐bound drugs, since pharmacologic activity can be influenced by the extent of albumin binding, in turn related to albumin concentration.
Appraisal of Ascorbic Acid for Acidifying the Urine of Methenamine‐Treated Geriatric Patients
Authors: NACCARTO DEBRA V. , BELL CHRISTINE J. , LAMY PETER P.
Published: April 2015

ABSTRACT: A study was made of 73 elderly patients receiving methenamine and ascorbic acid concurrently. Each patient had an indwelling Foley catheter. Urinary pH was assessed in relation to the dosage of ascorbic acid, duration of therapy, formulation, and dosing intervals for ascorbic acid and methenamine. Statistical analysis revealed a significant increase in urinary pH when the dosage of ascorbic acid was increased. No significant relationships were found between urinary pH and the dosage forms of ascorbic acid, the salt of methenamine used, or the duration of methenamine therapy. Changes in urinary pH at different dosing intervals for ascorbic acid were found to be significant, at the 10 percent level only, for the three‐times‐daily dose schedule. These data raise a question as to the value of ascorbic acid for acidifying the urine of catheterized patients receiving methenamine therapy.
Stomach Cancer in Various Age Groups (Japan) As Detected by Gastric Mass Survey
Authors: HISAMICHI SHIGERU , SASAKI RIKURO , SUGAWARA NOBUYUKI , YANBO TOORU , YAMAGATA SHOICHI
Published: April 2015

ABSTRACT: In order to determine the characteristics of stomach cancer in the elderly, statistical analyses were made of 2,366 cases found in a gastric mass survey (group 1) and 194 cases found among 9.196 persons over age 40 observed during 13 years (group 2). For group 1, the average annual incidence of stomach cancer per 100,000 persons by age, and the death rate by age, increased as age advanced. The average annual incidence was 0.19 percent over 18 years and there were almost no changes in the detection rate. For group 2, the death rate per 10,000 persons in the examined group was significantly lower than in the non‐examined group, especially for persons in their 50's or 60's. However, there were no differences in the death rate for persons in their 40's, 70's, and beyond. The rate for surgical resection of cancer and the incidence of early stomach cancer were lower in the elderly; the 5‐year relative survival rate was poor. Thus, the clinical characteristics of stomach cancer in the elderly include the following aspects: 1) in mass surveys, the incidence of stomach cancer is highest in the elderly, especially for men; 2) many cases of stomach cancer are advanced or inoperable; and 3) most of these patients do not undergo examination until they become aware of symptoms related to cancer.
Regulation of Bowel Function by a Laxative/Stool Softener Preparation in Aged Nursing Home Patients
Authors: MADDI VINCENT I.
Published: April 2015

ABSTRACT: A 12‐week program for 42 chronically constipated patients in a nursing home involved a graduated dosage regimen of standardized senna concentrate with dioctyl sodium sulfosuccinate (Senokot‐S Tablets), a high‐fiber diet, and an increased fluid intake. The program achieved a satisfactory pattern of bowel evacuation in 36 (86 percent) of these patients. This pattern, as observed during a 4‐week follow‐up period while therapy was continued, was characterized by absence of fecal impactions, regular comfortable bowel movements of appropriate consistency, minimal or no straining at stool, and minimal or no resort to enemas. In the initial 2‐week control period, none of the 42 patients had responded adequately to only dietary modification and increased hydration. Six additional patients whose response to the control regimen was equivocal, also appeared to benefit from the medication program. Two of these were able to discontinue the laxative tablets completely by the end of the 12‐week test period. None of the 48 patients who completed the course experienced any adverse effects related to this rehabilitative program.
Effects of Antihypertensive Treatment on Left Ventricular Hypertrophy in Patients with Essential Hypertension
Authors: YAMADA TAKASHI , KUBOTA TETSUHIRO , ENDO TOYOSHI , KOMATUS HIDETADA , OBA MITSUFUMI , NAGATA HAJIME , IZUMIYAMA TOMIO
Published: April 2015

ABSTRACT: In an attempt to determine which type of antihypertensive drug is more effective in reducing left ventricular hypertrophy (LVH), thiazide, α‐methyldopa, hydralazine and propranolol were administered singly or in combination to patients with essential hypertension, and to spontaneously hypertensive rats (SHR). QRS voltage [S1 + R5(or R6)] in the electrocardiogram (ECG), the cardio‐thorax (C/T) ratio in chest x‐ray films, and the heart weight were used to assess regression of LVH and cardiomegaly. The S1 + R5(or R6) and the C/T ratio were well correlated with the pretreatment systolic blood pressure. Adequate blood pressure control produced regression of S1 + R5(or R6) and the C/T ratio, but the change in QRS voltage remained the earlier and more reliable sign of LVH for evaluating the effectiveness of therapy. The regression of QRS voltage and heart weight occurred regardless of which type of therapeutic drug was used in patients with essential hypertension and in SHR. It is suggested that LVH is directly related to the height of arterial pressure and that lowering of arterial pressure can be followed by regression of ECG‐LVH regardless of the type of depressive drug used.
Evaluation of the Effectiveness of Reality Orientation Classes in a Nursing Home Unit
Authors: CORNBLETH TERRY , CORNBLETH CATHERINE
Published: April 2015

ABSTRACT: The effectiveness of a geriatric treatment program is determined largely by the extent to which it contributes to enhanced independent functioning. To examine the effectiveness of Reality Orientation (RO) classroom instruction, the verbal orientation and the everyday behavior of 22 residents in a Veterans Administration Nursing Home Care Unit were assessed before and after their participation in RO classes. The classes met five days a week for three months. Participants showed a significant increase in verbal orientation (as measured by the Reality Orientation Questionnaire) and a significant improvement in independent functioning (as measured by the Geriatic Resident Goals Scale). The results provide evidence of the effectiveness of RO as a treatment procedure for disoriented geriatric residents.
Systemic Lupus Erythematosus in the Older Age Group: Computer Analysis
Authors: DIMANT JACOB , GINZLER ELLEN M. , SCHLESINGER MICHAEL , DIAMOND HERBERT S. , KAPLAN DAVID
Published: April 2015

ABSTRACT: A computer analysis was made of the data from a prospective study of the clinical course of systemic lupus erythematosus (SLE) in 234 patients followed for an average of 46 months. All fulfilled four ARA criteria for the diagnosis of SLE. Sixteen of the 234 patients were aged 51 or older. They were compared with the 218 younger SLE patients to determine the influence of age on the signs and symptoms of the disease, the organ systems involved, the laboratory data, amount and duration of corticosteroid or azathioprine therapy, and the prognosis. The older group showed more discoid lupus, photosensitivity and pulmonary fibrosis than did the younger group, but a similar incidence of malar rash, alopecia, arthritis, arthralgia, myalgia and serositis, and a lower incidence of oral ulcers, Raynaud's phenomenon, cutaneous vasculitis, neuropsychiatric manifestations, leukopenia, hypocomplementemia and profuse proteinuria. The older patients needed a lower dosage of corticosteroids, and a shorter course of azathioprine therapy. These findings suggest a milder form of SLE with better response to therapy in the older age group.
Medical Care Evaluation Studies in Long‐Term Care Facilities*
Authors: ZIMMER JAMES G.
Published: April 2015

ABSTRACT: This report describes the selection, design, conduct, analysis, and application of medical care evaluation studies in long‐term care facilities (skilled nursing homes) in a regional program in the Rochester region of upstate New York. Eight examples are presented to highlight methodologic approaches and problems. They are classified under four general headings: Administration Audits, Diagnosis‐specific Studies, Care Modality‐specific Studies, and General Outcome Indicators. The implementation of results and recommendations from the studies is discussed and an application of “tracer” methodology for assessing the components of care activities in long‐term facilities is described. Problems and challenges in long‐term quality care are outlined.
Sexuality in Nursing Homes
Authors: WASOW MONA , LOEB MARTIN B.
Published: April 2015

ABSTRACT: Since so little has been written on the subject of sexuality among the elderly in nursing homes, a study was conducted in some nursing home populations in Wisconsin. Resistance was encountered in certain areas but finally 63 residents (27 men and 36 women) agreed to be interviewed. A recently designed questionnaire was used, followed by a relaxed conversational period. Our findings indicate that the aged interviewees believed that sexual activity was appropriate for other elderly people in the homes; they personally were not involved, chiefly because of lack of opportunity. Most of them admitted having sexual thoughts and feelings. Medical and behavioral personnel showed great reluctance to discuss the subject. It would seem that, if the quality of life in old age is to be improved, there should be some provision in nursing homes for those who desire appropriate sexual activity.
Prosopo‐Affective Agnosia Associated with Chronic Organic Brain Syndrome
Authors: KURUCZ JANOS , FELDMAR GABRIEL , WERNER WILLIAM
Published: April 2015

ABSTRACT: Impairment of the ability to recognize facially expressed emotions was studied in 14 chronically disoriented patients with chronic organic brain syndrome (CBS). This impairment was named prosopo‐affective agnosia (PAA). A diagnostic requirement was relatively intact neurologic functioning in underlying perceptual‐verbal‐motor processing. A test was designed for facial‐affect recognition in the accurate differentiation of normal persons from chronically disoriented CBS patients. No normal subject made any errors in this test. Despite decades of illness and hospital living, patients with a history of schizophrenia or major affective disorders scored almost at a normal level (95 vs. 100 percent) in this test, and significantly higher (95 vs. 66 percent) than did the disoriented CBS patients. The social and therapeutic implications of the findings are stressed. CBS patients may be impaired with respect to receiving and appreciating elementary aspects of social communications such as recognizing a smile, anger, sadness or disapproval on the faces of people who surround them. This disability requires understanding and a special attitude on the part of the therapeutic team toward such patients.
Simple Primary Tuberculosis in an Elderly Woman
Authors: ALEXANDER W. JAMES , AVENT C. KIRK , BAILEY WILLIAM C.
Published: April 2015

ABSTRACT: The diagnosis of primary tuberculous infection was made in a 78‐year‐old woman. The chest roentgenographic findings were remarkably similar to those often seen in children and adolescents with primary infection. Like the majority of adults with this entity, the patient was asymptomatic; the diagnosis was suspected epidemiologically and was confirmed by culture of M. tuberculosis from the sputum. As the incidence of new tuberculosis cases declines, the diagnosis of primary tuberculosis in the adult may be made more frequently.
Electroencephalographic and Clinical Changes as Correlated in Geriatric Patients Treated Three Months with an Ergot Alkaloid Preparation
Authors: MAT[EJCEK MILAN , KNOR KAREL , PIGUET PIERRE‐V , WEIL CLAUDE
Published: April 2015

ABSTRACT: The results of a 3‐month trial with an ergot alkaloid preparation (Hydergine) in 16 geriatric patients showed that, in accordance with a previously proposed working hypothesis, the improvement induced by the drug in electroencephalographic age‐related changes was accompanied by clinical improvement in patients with similarly age‐related mental deterioration.
Relativd Efficacy of Carbenicillin Indanyl Sodium and of Trimethoprim/ Sulfamethoxazole in Urinary‐Tract Infections
Authors: SENECA HARRY
Published: April 2015

ABSTRACT: In a 10–day study, carbenicillin indanyl sodium cured urinary‐tract infections in 22 of 30 patients (ages, 24–91). In 3 of the remaining patients the treatment was a failure; in 3 others the drug had to be discontinued because of diarrhea and vomiting; and in 2 instances it induced overgrowth of Candida albicans in the urine. Carbenicillin was lethal to Pseudomonas aeruginosa in all 9 cases, to Proteus mirabilis in all 6 cases, and to enterococcus in all 3 cases. A trimethoprim/sulfamethoxazole combination cured urinary‐tract infections in 18 of 30 other patients (ages, 28–91), but failed in 3. In 3 patients it gave rise to a skin rash; in 2 to elevation of blood urea nitrogen and creatinine levels; in 1 to neutropenia; and in 1 to overgrowth of Candida albicans in the urine. Reinfection occurred in 2 patients. Carbenicillin indanyl sodium was more effective than the sulfonamide/trimethoprim combination.