bluuebunny/crossref_metadata_2025 huggingface dataset:
Studies in Geriatric Education: I. Developing Educational Objectives
Authors: ROBBINS ALAN S. , FINK ARLENE , KOSECOFF JACQUELINE , VIVELL SUSAN , BECK JOHN C.
Published: April 2015

This study reports on the development of a comprehensive set of objectives for the education of undergraduates, graduates, and fellows in geriatric medicine. The objectives were derived from reviews of available educational materials and programs, and their significance was validated through consensus techniques that included over 100 workers with special expertise in geriatrics and gerontology from the United States, Canada, and the United Kingdom. A related and supplementary investigation, which also used consensus methods, uncovered ten general and disease‐specific objectives considered to be essential outcomes of the education of geriatric fellows. Academic departments and specialty and subspecialty organizations should find the total set of objectives useful for planning and evaluating educational programs in geriatrics.
Decubitus Ulcer Prevention
Authors: SEILER WALTER O. , ALLEN SUSAN , STÄHELIN HANNES B.
Published: April 2015

Sacral skin oxygen tension, measured by a noninvasive technique in ten healthy subjects, remained in the normal range when they were lying on a “super‐soft” mattress or in the 30° lateral position. Therefore, these methods are effective in decubitus ulcer prevention. Skin oxygen tension measurement allows immediate assessment of the efficacy of measures to prevent decubitus ulcers.
Infectious Diseases and Aging: Immunologic Perspectives
Authors: FELSER JAMES M. , RAFF MARTIN J.
Published: April 2015

Four theories of aging provide a basis for understanding both the aging process and the primary alterations in host defenses that may occur with age. The immunologic theory of aging may be especially important in this regard, since immunologic defects may be responsible for many manifestations of aging, and a decline in immune function may also underlie the increased susceptibility of the aged to infection. However, multiple factors are probably responsible for the aging process and for changes in host defenses. Although several studies attempting to enhance the immune response of elderly persons and perhaps extend lifespan are in progress, no factor at present appears to be as important in this regard as three underutilized immunizations for influenza, pneumococcal infection, and tetanus.
A Geriatric Special‐care Unit: Experience in a University Hospital
Authors: SAUNDERS RICHARD H. , HICKLER ROGER B. , HALL SANDRA A. , HITZHUSEN JANICE C. , INGRAHAM MERLE R. , LI LYNN
Published: April 2015

Responding to a perceived need for specialized care for the acutely ill elderly, a 14‐bed geriatric special‐care unit was established in the University of Massachusetts Hospital in January 1980. Patients were selected for admission after assessment of their potential to benefit from restorative care. Most patients were admitted from the emergency room or outpatient clinics or were scheduled admissions; a few were in‐hospital transfers. This report deals with a retrospective analysis of the first 514 admissions (431 patients) to the unit. Admissions by major service were: Medicine, 64 per cent; Surgery, 14 per cent; Neurology, 10 per cent; Orthopedics, 7 per cent; and other, 5 per cent. Approximately 64 per cent of patients were between the ages of 70 and 84. The overall average length of stay per admission was 11.5 days. Mortality rate of patients undergoing surgery (n = 125) was 4 per cent. The percentage of admissions that were discharged home was 78.7 per cent. Only 7.3 per cent of admissions were discharged to a nursing home, when those that were admitted to the unit from a nursing home are excluded. The authors conclude that a special nursing unit for acutely ill elderly patients may serve several purposes in a university hospital: overall patient care may be improved; length of hospital stay may be shortened; and medical students, housestaff, and attending physicians may gain an opportunity to learn the fundamentals of geriatric medicine as demonstrated by the staff of the unit.
Utilization of Psychiatric Consultation for Elderly Patients
Authors: RABINS PETER , LUCAS MARY JANE , TEITELBAUM MARK , MARK SHARON REYNOLDS , FOLSTEIN MARSHAL
Published: April 2015

Six hundred fifty‐one psychiatric consultations performed during a one‐year period were reviewed retrospectively. Cognitive impairment was present in 54 per cent and depression in 27 per cent of the elderly patients in the population studied. A second study of the point prevalence of cognitive and emotional disorders in the hospital was carried out using the Mini‐Mental State Exam and the General Health Questionnaire. Emotional disorders had similar prevalences in all age groups but cognitive disorders were more common in the elderly. Twenty‐one per cent of consultations were done on patients over the age of 60, although elderly patients occupied 28.5 per cent of hospital beds. Thus, elderly patients were less often referred for psychiatric consultation than younger patients, although the incidence of psychiatric disorders increases with age.
The Frequency of Physical Signs Usually Attributed to Meningeal Irritation in Elderly Patients
Authors: PUXTY J. A. H. , FOX R. A. , HORAN M. A.
Published: April 2015

Nuchal rigidity, which may be a sign of meningitis, was found in 35 per cent of geriatric patients on acute‐care and rehabilitation wards and in 13 per cent of younger patients on an acute‐care ward. It was significantly associated with cerebrovascular disease, confusion, abnormal plantar responses, and primitive reflexes. Elderly patients who have nuchal rigidity with no history of neurologic or cognitive disorders should be investigated for meningitis.
Degenerative Calcific Valvular Disease and Systolic Murmurs in the Elderly
Authors: WONG MAYLENE , TEI CHUWA , SHAH PRAVIN M.
Published: April 2015

By use of echocardiography and radiologic imaging, a prospective study was made of 98 elderly men, 65 to 102 years old, to define degenerative calcific valvular disease (DCVD)—its prevalence, morphologic features, functional significance, and relationship to systolic murmurs in the elderly. DCVD was diagnosed in 74 per cent of the group and murmurs were detected in 55 per cent, the incidences increasing with age. Fibrotic and calcific change of the aortic valve was the most common abnormality, occurring alone or together with alteration of the mitral valve. The murmurs were characteristically early systolic, of low intensity and medium pitch, and heard at more than one area. Of the group with valve degeneration, only 7 per cent was judged to be functionally significant and no more than moderate. It was concluded that DCVD is the cause of most systolic murmurs in the elderly and is usually hemodynamically unimportant. Echocardiographic criteria are important in identifying those subjects with possibly significant valvular dysfunction requiring invasive study.
The Nonuse of Urethral Catheterization in the Management of Urinary Incontinence in the Teaching Nursing Home
Authors: MARRON KATHLEEN R. , FILLIT HOWARD , PESKOWITZ MYRA , SILVERSTONE FELIX A.
Published: April 2015

A survey of all patients in a 527‐bed skilled nursing facility was carried out to determine the prevalence of bladder catheterization. The institution surveyed is a teaching nursing home and rehabilitation center comprising three intermediate‐stay and rehabilitation units of 126 beds and nine long‐term care units.

The institutional prevalence of recurrent urinary incontinence was 46 per cent, or 243 patients. The prevalence of chronic indwelling urethral catheters was 2.5 per cent, or 13 patients. The prevalence of urethral catheterization was further reduced to 1.5 per cent on the long‐term care units, where the rate of recurrent urinary incontinence exceeded 60 per cent.

The results of our survey were then compared with similar surveys at the institution during the years 1975 through 1980. Despite a fluctuating but increasing prevalence of incontinence over the years studied, a favorable trend was shown toward a reduction in the number of patients with indwelling urethral catheters.

This study indicates that unless specific complicating factors are present, urinary incontinence in all but a very few of the elderly can be successfully managed without chronic indwelling catheterization. The authors believe that the introduction and growth of an education and research program in the nursing home environment has led to improvement in the standards of medical and nursing care.
Gynecologic Sepsis as a Cause of Covert Infection in Old Age
Authors: HORAN MICHAEL A. , PUXTY JOHN A. H. , FOX ROY A.
Published: April 2015

Three cases of endometritis, which presented covertly in elderly women, are described. All three patients were in a poor state of nutrition, and two had serious intercurrent disease. It is believed that cyclical shedding of the endometrium and “normal” vaginal flora (under the influence of estrogen) are the major defenses against infection. These are lost after the menopause, and were therefore absent in the three patients described here. The waning of the immune response associated with aging, particularly the progesterone‐stimulated uptake of polymeric IgA in the endometrium, may be important, as may the immunosuppressive effect of malnutrition. It is suggested that a nonspecific deterioration in an elderly woman or infection of uncertain site should prompt a careful re‐examination, including a thorough pelvic examination.
Hand Weakness in the Elderly
Authors: HARRELL LINDY E. , MASSEY E. WAYNE
Published: April 2015

Hand weakness is an important but frequently overlooked problem in the elderly. The exact diagnosis is often difficult because of the complexities of innervation and muscle function. An anatomic approach to the diagnosis of isolated hand weakness in the elderly is presented. Causes, evaluation, and therapy for various forms of this symptom are reviewed.
Where Do Elderly Patients Prefer to Die?
Authors: GROTH‐JUNCKER ANNEMARIE , McCUSKER JANE
Published: April 2015

This report describes the places of death of 100 elderly home‐bound patients served by a home health care team. It compares some medical and psychosocial characteristics of the patients who died at home and the patients who died in an institution, and examines the factors that lead to death in an institutional setting for patients who had planned to die at home. All patients at the time of admission to team care had wished to receive care at home. The preferred place of death or type of care when death became imminent were not discussed at that time. Of the 100 patients who died, 55 died in their own homes and 43 died either in a hospital (33 patients) or in a nursing home (ten patients). Two patients died unexpectedly, either at home or on their way to the hospital. Sociodemographic variables such as age, sexual gender, Medicaid status, living arrangements, diagnosis, and pain level did not appear to be related to place of death. The patient's expressed wish for one or the other option seemed the key factor. Failure to provide death at home to 19 patients was mostly due to a prolonged terminal phase leading to emotional and physical exhaustion in the patient or the family.
Hypernatremic Dehydration in Nursing Home Patients
Authors: HIMMELSTEIN DAVID U. , JONES ALICE A. , WOOLHANDLER STEFFIE
Published: April 2015

In order to determine the antecedents of hypernatremic dehydration the authors reviewed the records of 56 patients with this condition at two public hospitals, one of which includes a large chronic care facility. Twenty‐nine patients developed hypernatremic dehydration while at nursing homes. All cases came from proprietary nursing homes, although proprietaries account for only 88 per cent of nursing home beds in the community studied (P < 0.05). There was a cluster of patients from two nursing homes. Sixteen patients admitted from home all showed evidence of inadequate care prior to admission. Eleven patients became hypernatremic while in acute care hospitals. No patient in the public chronic care facility developed hypernatremic dehydration during the period studied. The average serum sodium concentration of patients transferred from nursing homes was significantly higher than that of patients who developed hypernatremic dehydration at home or in acute care hospitals. It is concluded that hypernatremic dehydration in an institutionalized patient may be an indicator of inadequate care, which should prompt further investigation of the living conditions of the patient.
Mortality Associated with Hip Fractures in a Single Geriatric Hospital and Residential Health Facility: A Ten‐year Review
Authors: CRANE JOHN G. , KERNEK CLYDE B.
Published: April 2015

Mortality in 159 patients who sustained 163 hip fractures in a single geriatric hospital and residential health facility in a ten‐year period was studied. This study confirms the major problem of mortality associated with hip fractures in the very elderly. Factors that seemed associated with mortality were preoperative and postoperative ambulatory status and the overall medical condition of the patients, as evidenced by the higher percentage of patients in the hospital who died after sustaining hip fractures. The age of these elderly patients did not seem to affect the type of fracture or the final outcome significantly.
Tardive Dyskinesia: Special Risk in the Elderly
Authors: JENIKE MICHAEL A.
Published: April 2015

Tardive dyskinesia has emerged as a considerable public health hazard. In view of the overwhelming evidence that the elderly are particularly susceptible to this complication of neuroleptic use and the fact that there is no really effective treatment, neuroleptics should be avoided whenever possible in elderly patients.
Hair and Serum Copper, Zinc, Calcium, and Magnesium Concentrations in Alzheimer‐type Dementia
Authors: Shore David , Henkin Robert I. , Nelson Neta R. , Agarwal Raghunath P. , Wyatt Richard Jed
Published: April 2015

Several research groups have reported alterations in mineral concentrations in patients with Alzheimer's disease (AD). A study of serum copper, zinc, magnesium, calcium, and albumin concentrations in outpatients with Alzheimer's disease (in the early‐to‐middle stages) and in these patients' healthy spouses is reported. Hair concentrations of copper, zinc, magnesium, calcium, and manganese were also measured in these AD patients and controls. No differences in serum or hair concentrations were found, and determinations of these hair and serum mineral concentrations do not appear to be of use in the diagnosis of AD. Significant positive correlations were found between age and hair manganese (Mn) in the control spouses, and a similar (but statistically nonsignificant) trend in the AD patients.
Diurnal Variation of Blood Pressure in Elderly Patients with Essential Hypertension
Authors: Kobrin Isaac , Oigman Willie , Kumar Ajay , Ventura Hector O. , Messerli Franz H. , Frohlich Edward D. , Dunn Francis G.
Published: April 2015

Twenty‐one elderly patients with essential hypertension, all over 65 years of age, were subjected to automated noninvasive 24‐hour blood pressure measurement. Readings were obtained every 7.5 minutes throughout the day. The data were analyzed with respect to: correlation between office and ambulatory pressure measurements; possible differences in the circadian blood pressure pattern; and the existence of hypertensive or atherosclerotic cardiovascular complications. In all patients, the office systolic pressures were significantly higher than the ambulatory daytime pressures; diastolic pressures were similar. At night, two patterns of blood pressure emerged. In one there was a further fall in both systolic and diastolic pressures to normotensive levels, whereas the other pattern revealed no change in diastolic pressure, although systolic pressure increased significantly to similar levels as measured in the office. The prevalence of hypertensive or atherosclerotic cardiovascular complications in the patients with the first pattern was significantly less than in the group of patients with the second pattern (chi square, P < 0.025). The data reported herein indicate that ambulatory blood pressure monitoring may help in the overall clinical evaluation of elderly patients with hypertension.
Cardiopulmonary Resuscitation of the Elderly
Authors: Gordon Michael , Hurowitz Eric
Published: April 2015

Cardiopulmonary resuscitation (CPR) has been practiced since 1960. In mixed‐age populations there is about a 10 per cent survival rate. Most CPR studies state that “age alone” is not a critical factor in survival. Studies that focus specifically on the elderly suggest that although “age alone” is not a critical survival factor, previous level of function and severity of underlying disease have major effects on CPR outcome. In most medical institutions CPR is undertaken unless a specific “do not resuscitate” order is written. Many impaired and chronically ill elderly therefore undergo unnecessary and unsuccessful CPR. The available data suggest that CPR is suitable for the independent and relatively well elderly to whom CPR measures can be quickly applied. For the chronically dependent and ill elderly, CPR in most instances should not be undertaken. Such an eventuality, however, should be anticipated and whenever possible discussed with patients and family members, thus allowing decisions to be made consciously rather than leaving them “to chance.”
A Community‐based Psychogeriatric Service
Authors: WASYLENKI DONALD A. , HARRISON MARY K. , BRITNELL JUDY , HOOD JANE
Published: April 2015

The elderly are most susceptible to mental illness, and they receive inadequate mental health services. The authors developed a community‐based program to meet the needs of the psychiatrically impaired elderly by providing a multiplicity of indirect services to community caregivers. A psychiatrist and two clinical specialists in psychiatric nursing provide consultation, education, collaboration, and coordination to individuals and agencies dealing directly with elderly clients in the community. Evaluation of data show a high degree of consultee satisfaction, few recommendations for institutional care, satisfactory client outcomes, and a significant impact achieved by a formal educational program for community practitioners.
Problems of Antiarthritic Therapy in the Elderly
Authors: BROOKS P. M. , KEAN W. F. , KASSAM Y. , BUCHANAN W. W.
Published: April 2015

Rheumatic diseases are prevalent in the elderly population, resulting in high morbidity caused mainly by lack of mobility. Consequently, the use of antirheumatic drugs in older persons is extensive. This review outlines some of the hazards encountered in the use of antirheumatic drugs in the elderly. Analgesics such as propoxyphene and acetaminophen are useful adjuncts to the treatment of arthritic pain, but propoxyphene has been associated with respiratory depression, and renal clearance of acetaminophen is reduced in elderly subjects. Salicylates may cause deafness, and like the other nonsteroidal anti‐inflammatory drugs, may cause salt and water retention resulting in congestive cardiac failure. Phenylbutazone should not be used because of the risk of blood dyscrasia, and indomethacin has been reported as interfering with the antihypertensive effect of β‐blockers. Chloroquine levels may be raised in patients with impaired renal function, and there is increased risk of retinal damage with the drug in elderly subjects. Injectable gold compounds and penicillamine are not contraindicated in the elderly, because they are just as efficacious as in younger persons for the treatment of rheumatoid arthritis. Toxicity due to gold compound is not increased in the elderly, but skin rashes and abnormalities of taste do occur more commonly in elderly patients treated with penicillamine. Corticosteroids do not affect disease progression and therefore should be used only in acute severe disease for short periods of time. As in the younger population, treatment of gout in the elderly is dependent on renal function. The treatment of rheumatic diseases in the elderly requires careful consideration of the metabolic consequences before a regimen of drug therapy is introduced. Properly managed drug therapy in the elderly arthritic patient will result in considerable improvement in mobility, thus greatly enhancing the quality of life.
Extraordinary Nutritional Support: A Case Study and Ethical Analysis
Authors: WATTS DAVID T. , CASSEL CHRISTINE K.
Published: April 2015

Ethical issues surrounding decisions to limit treatment often focus on dramatic and highly technical interventions, such as mechanical ventilation. Many less dramatic forms of therapy are considered routine,1 and ethical aspects of their use may be less closely examined. Nutritional support can be crucially important in elderly patients, especially the very frail. Yet, appropriate use of nutritional therapy must consider the circumstances of an individual patient. Where severe underlying illness cannot be reversed, technical means of providing nutrition can represent extraordinary rather than ordinary means of prolonging life. The following case examines the ethical issues in respecting the apparent refusal of nutritional support by a severely debilitated geriatric patient.
The Immune Status of Healthy Centenarians
Authors: THOMPSON JOHN S. , WEKSTEIN DAVID R. , RHOADES JOSEPH L. , KIRKPATRICK CHARMAINE , BROWN STEPHEN A. , ROSZMAN THOMAS , STRAUS ROBERT , TIETZ NORBERT
Published: April 2015

The immune status of 17 healthy individuals 100–103 years of age (centenarians) was investigated. Qualitative values for immunoglobulins IgG, IgM, IgA, and IgE were within normal ranges for subjects more than 60 years of age with the exception of elevated IgM in one individual. Cell marker studies employing a panel of 27 monoclonal antibodies delineating T and B lymphocytes, monocytes, natural killer cells, granulocytes, and functional and developmental subsets of each were performed to phenotype the peripheral blood leukocytes. Although the total lymphocyte count was normal in every subject, the numbers of T4‐positive helper–inducer T lymphocytes were profoundly depressed, as were responses to the mitogen phytohemagglutinin and interleukin‐2 production. Activated immature T lymphocytes and the number of cells bearing the phenotype of natural killer cells were increased, but natural killer cell activity was normal. Early B lymphocytes were also increased. The relative concentration of monocytes was normal. Taken together these findings indicate that the immune system in centenarians is similar to that in younger but still elderly individuals, i.e., discriminating T‐lymphoid functions are reduced in association with an apparent failure of some T, B, and natural killer cells to differentiate to functional maturity.
Hospital Use by the Extremely Elderly (Nonagenarians): A Two‐year Study
Authors: PATTERSON CHRISTOPHER , CRESCENZI CAROLINE , STEEL KNIGHT
Published: April 2015

Eighty‐seven community‐dwelling nonagenarians provided with extensive medical and social services as needed were followed for two years. Fifty‐one subjects were admitted to an acute care hospital at least once. Total durations of hospitalization for those who required it averaged 44 days per individual over the two years. This represents about 13 hospital days per year per nonagenarian. Since it is likely that few, if any, hospitalizations would have been preventable by additional services, these data suggest that at a minimum one hospital bed would be continuously occupied for every 28 persons of this age and of this degree of infirmity. In these times of fiscal restraint it is especially important that the government and third‐party payers determine the level of funding for expensive services such as acute hospitalization by assessing the needs of those who use them.
Geriatric Consultation: A Functional Approach
Authors: LICHTENSTEIN HOWARD , WINOGRAD CAROL HUTNER
Published: April 2015

Eighty‐one geriatric consultations conducted on behalf of 71 patients (mean patient age 78 years, range 59–99; M34, F37) at San Francisco General Hospital were analyzed. Seventy‐nine per cent of requests were for medical or psychiatric evaluation; 19 per cent social; and 3 per cent rehabilitation. The authors made 50 new diagnoses, many of which identified conditions that adversely affected patients' functional levels, including cardiovascular disorders (8), medication effects (8), malnutrition (7), misdiagnosis of dementia (7), and gait disorders (4). Recommendations focused on treating those conditions whose alleviation could improve self‐care ability: medication adjustment (62 per cent), management of dementia, delirium, or depression (59 per cent), rehabilitation (32 per cent), and treatment of malnutrition (30 per cent). Geriatric consultations resulted in rerouting 18 patients (51 per cent) from nursing homes to lower levels of care. Fourteen of these eventually returned home. By focusing on reversible conditions that affect patients' functional levels, geriatric consultation can improve the management of elderly patients and prevent unnecessary nursing home placement.
Categories of Family‐mediated Abuse and Neglect of Elderly Persons
Authors: O'MALLEY TERRENCE A. , O'MALLEY HELEN C. , EVERITT DANIEL E. , SARSON DEBORAH
Published: April 2015

The records of 22 cases of family‐mediated abuse and neglect of elderly persons were retrospectively reviewed by the physician and nurse responsible for their care using a modification of the OARS Multidimensional Functional Assessment form. Cases were divided into three categories: Category I cases (n = 4) involved extremely impaired elders who received extensive care from the individuals responsible for the abuse or neglect. Category II cases (n = 9) involved impaired elders who received inadequate or intermittent care. Category III cases (n = 9) involved independent elders whose only care needs resulted from threats or violence from relatives. Among the statistically significant differences found between these categories were the age of the abuser, the manifestations of abuse or neglect, the interventions offered, the durations of abuse, and the outcomes of the cases. The results suggest that these three categories represent different subgroups of abused and neglected elderly persons, all with different implications for identification, intervention, and outcome.
Association of Hypertension with Increased Atrophy of Brain Matter in the Elderly
Authors: HATAZAWA JUN , YAMAGUCHI TATSUO , ITO MASATOSHI , YAMAURA HARUTSUGU , MATSUZAWA TAIJU
Published: April 2015

Atrophy of brain matter in hypertensive and normotensive subjects was studied by quantitative measurements of brain volume and cranial cavity volume using x‐ray computed tomography. The 123 normotensive subjects ranged in age from 20 to 79 years and were divided into six ten‐year age groups. The 67 hypertensive subjects ranged in age from 40 to 83 years and were divided into four age groups. Values of the brain volume index (BVI), the ratio of brain matter volume to cranial cavity volume, for hypertensives and normotensives in the same age groups were compared. Mean BVI values were significantly lower in hypertensives in the fifth (P < 0.01), sixth (P < 0.01), seventh (P < 0.05) and eighth and ninth decades of life (P < 0.001). Systemic hypertension, which may induce various diseases in the elderly, had a striking effect on atrophic changes of brain matter in elderly subjects.
Future Concerns and Recent Life Events of Elderly Community Residents
Authors: STEIN SHAYNA , LINN MARGARET W. , SLATER ELISA , STEIN ELLIOTT M.
Published: April 2015

Fifty‐eight elderly community residents completed a 37–item inventory that measured their level of concern about potentially stressful events or emotions. Afterwards, they indicated whether selected life events had actually occurred in the last six months. All data were intercorrelated to determine if there were relationships between total scores, personal characteristics, and recent life events. Results showed elderly persons in this sample to be most worried about immediate economic survival and disability. Those in poorer health who had less education, were living with their children, and had less tenure in the neighborhood evidenced greater total concern.
Use of Health Care Services by Older Hispanics
Authors: LOPEZ‐AQUERES WALDO , KEMP BRYAN , STAPLES FRED , BRUMMEL‐SMITH KENNETH
Published: April 2015

This paper presents information regarding older Hispanics' use of health care services in an urban setting. Using the Comprehensive Assessment and Referral Evaluation (CARE) questionnaire, data on patterns of health care use and correlates of health services utilization were collected from a sample of 704 Hispanics age 60 and over residing in Los Angeles County. The results indicate that during the year preceding the interview, 79.4 per cent of the respondents saw a physician and 10 per cent were hospitalized. Of those seeing a doctor, 83.5 per cent saw a general practitioner and 32.6 per cent a specialist. When requiring medical care, respondents said that they would go to local private doctors (49.9%), hospitals (26.7%), neighborhood clinics (18.6%), and Mexico (2%). Further analysis revealed that some utilization measures varied significantly according to respondents' sociodemographic and economic correlates such as age, language, income, and availability of health insurance.
The Sepulveda VA Geriatric Evaluation Unit: Data on Four‐year Outcomes and Predictors of Improved Patient Outcomes
Authors: Rubenstein Laurence Z. , Wieland Darryl , English Patricia , Josephson Karen , Sayre James A. , Abrass Itamar B.
Published: April 2015

Data from its first four operating years indicate that the Sepulveda VA Geriatric Evaluation Unit is having consistent beneficial effects on patient care. These benefits include improved diagnostic accuracy, reduced use of drugs, improved functional status, and improved placement location. However, not all patients benefit equally, and differences between patient responses highlight the need to select those who will benefit most from relatively costly Geriatric Evaluation Unit services. Discriminant and regression analyses were performed on 98 consecutive patients to determine which patients admitted to the Geriatric Evaluation Unit would show greatest improvement in terms of placement, functional status, one‐year survival, and living location, and which patients would be treated most efficiently in terms of length of stay. Patient characteristics on admission significantly associated with discharge home included a relatively high functional and cognitive status, the absence of an unstable medical problem, and not being expected to need nursing home placement by the referring physician. The latter two factors alone predicted actual placement location on the next 101 patients admitted to the Geriatric Evaluation Unit with high predictive accuracy (88.5 per cent). Factors predictive of patients whose functional status would improve on the Geriatric Evaluation Unit included absence of an unstable medical problem and being over 75 years old (predictive accuracy was 82.5 per cent). Two major factors associated with long patient stays on the Geriatric Evaluation Unit were low functional status scores and not living in own home or with family. These analyses indicate criteria that may be useful in selecting patients for inpatient geriatric evaluation and rehabilitation programs.
The Value of Annual Medical Examinations in the Nursing Home
Authors: Irvine Patrick W. , Carlson Kurt , Adcock Madeline , Slag Michael
Published: April 2015

Although annual medical examinations are required in many nursing homes for all residents, little is known about the value of these examinations. To investigate this, 732 annual examinations were evaluated for frequency of positive findings and clinical importance of the findings. Although 51 per cent of examinations yielded a finding that was new or related to a known chronic disease process, only 3 per cent of findings were judged by primary care physicians to be of major importance. Approximately a fourth of findings were considered to be of intermediate importance. These results provide only modest support for endorsing annual medical examinations for nursing home residents.
Circulating Vitamins in Alzheimer's Dementia as Compared with Other Dementias
Authors: Scileppi Kenneth P. , Blass John P. , Baker Herman G.
Published: April 2015

Blood levels of 12 vitamins were compared in 55 patients with Alzheimer's disease and 58 control subjects (10 intellectually alert, 12 depressed, 28 multi‐infarct dementias, 8 with other specific dementias). No significant differences in vitamin blood levels were found between the Alzheimer's disease group and the control groups either individually or in total. Conventional parenteral vitamin treatment of seven patients with vitamin deficits did not benefit their cognitive state. Conventional vitamin malnutrition did not seem to contribute to the disability in these subjects.
Interdisciplinary Training for Medical and Nursing Students: Learning to Collaborate in the Care of Geriatric Patients
Authors: CROEN LILA G. , HAMERMAN DAVID , GOETZEL RONNIE Z.
Published: April 2015

A medicine clerkship for students at the Albert Einstein College of Medicine provided the setting for a pilot program in interdisciplinary geriatric training with nursing students from the College of Mount Saint Vincent. The program's objectives were to provide opportunities for interdisciplinary collaboration and to increase appreciation for the role of each discipline in caring for the aged. Additionally, it sought to foster a holistic approach to the aging and a recognition of the psychosocial influences on their lives. Teams of one medical and two nursing students conducted patient work‐ups and presented cases to an interdisciplinary group of health care professionals. Analysis of pretest–posttest responses of ten medical and ten nursing students to a Role Assessment Questionnaire (RAQ) found that the program significantly increased medical students' perceptions of the nurse's role in caring for hospitalized elderly patients (P < 0.05). Despite this gain, however, there continued to be substantial discrepancies between medical and nursing students' perceptions of the extent to which nurses are “essential” in caring for the elderly. In evaluating the program, all participants concurred that working with students in another health profession was a valuable learning experience. While nursing students felt that the program achieved all its goals, responses of medical students were more variable, with volunteers having more positive perceptions of program impact than those who were assigned. The program demonstrated both the need for and the effect of interdisciplinary training, and that teaching and clinical experiences centering around the hospitalized older person can provide a natural setting for such training.
Causes for Hospitalization of Nursing Home Residents: The Role of Infection
Authors: IRVINE PATRICK W. , VAN BUREN NANCY , CROSSLEY KENT
Published: April 2015

Little is known about specific clinical conditions that lead to hospitalization of nursing home patients. To explore this, the authors examined the hospitalizations of 128 nursing home residents and compared them with hospitalizations of 320 patients from the outpatient clinic. Hospitalized nursing home patients were older, were admitted to medical services more frequently, and had more nonspecific complaints on admission. Nursing home patients were hospitalized most frequently for diseases of the circulatory system (16 per cent), respiratory system (14 per cent), and genitourinary system (12 per cent); clinic patients, for diseases of the circulatory system (25 per cent) and nervous system (10 per cent), neoplasms (10 per cent), and signs and symptoms of ill‐defined conditions (10 per cent). The most frequent causes of hospitalization for all patients were diseases of the circulatory system (23 per cent), nervous system (10 per cent), and neoplasms (10 per cent). Among patients from the nursing home, infections caused substantially more admissions (27 per cent) than among patients originating from clinic (12 per cent; P < 0.001). These findings disclose an important opportunity to reduce health care costs and enhance quality of life in the nursing home, particularly through the treatment and control of infections.
Severe Symptomatic Hyponatremia in Elderly Outpatients: The Role of Thiazide Therapy and Stress
Authors: BOOKER JOHN A.
Published: April 2015

Severe symptomatic hyponatremia (serum sodium level 112 ± 5.5 mEq/l) was encountered in six elderly outpatients within tour days of the onset of thiazide therapy. Associated polydipsia was present in two of these patients, but the thiazides alone appeared responsible in the others. In three other elderly outpatients, severe hyponatremia (serum sodium level 112 ± 5.25 mEq/l) developed after the acute emotional stress of relocation from their place of abode to a nursing home or hospital. Recurrent episodes of hyponatremia occurred in two patients following reinstitution of diuretic therapy, and, in two other patients, was precipitated by thiazides and stress on different occasions. Severe neurologic manifestations occurred in all patients and were mostly attributed to atherosclerotic dementia or stroke. Two patients died with severe hyponatremia, although all patients in whom cessation of thiazide therapy and water restriction were instituted promptly recovered without permanent sequelae.
Bone Changes and Aortic Calcification in Aging Inhabitants of Mountain Versus Seacoast Communities in the Kii Peninsula
Authors: FUJITA TAKUO , OKAMOTO YUKIHARU , SAKAGAMI YOSHIYUKI , OTA KIICHIRO , OHATA MASAHIRO
Published: April 2015

Bone changes and aortic calcification were compared radiographically for different age groups of the inhabitants of two communities on the Kii Peninsula at the central southern tip of the Japanese mainland, one a mountainous Shichikawa village with a traditionally restricted nutritional intake and the other a seacoast village on Oshima Island with an abundant nutritional supply. Changes in the physical properties of the bone were also assessed by resonance measurement. In the mountainous village, bone loss appeared to occur more rapidly than in the seacoast village, as indicated by a signficantly higher frequency of thoracic vertebral deformity and more pronounced age‐bound decrease of ulnar resonant frequency. Aortic calcification was also more frequent in Shichikawa than on Oshima Island. Such differences were more evident in women than in men. The poorer nutritional intake (especially of calcium and vitamin D) of persons living in the mountainous village (which receives less sunshine) might be responsible for the accelerated age‐bound degenerative changes observed in their skeletal and vascular systems.
Computerized Data Base for Evaluation and Follow‐up of Demented Outpatients
Authors: Zemcov Alexander , Barclay Laurie L , Brush Dorothea , Blass John P.
Published: April 2015

In the course of evaluating and following more than 600 geriatric outpatients referred to a subspecialty clinic because of cognitive impairment, standardized computer‐compatible evaluation and follow‐up forms were developed, as well as a computerized data base. The forms cover medical, neurologic, psychiatric, psychometric, and clinical laboratory examinations; they help health professionals to perform thorough, standardized, and efficient examinations focused on those characteristics relevant to dementias. The computerized data base facilitates follow‐up and other clinical studies. This article presents both the forms and their translation into query‐language terminology.
Book Reviews
Authors: Barzel Uriel S. , Aldridge Gordon J.
Published: April 2015

Psychosocial Rehabilitative Programs for Older Adults. By Saxon SV and Etten MJ. Springfield, Illinois, Charles C. Thomas, 1984, 154 pages, $19.75
Behavioral Correlates of Computed Tomographic (CT) Scan Changes in Older Psychiatric Patients
Authors: Swigar Mary E. , Benes Francine M. , Rothman Stephen L. G. , Opsahl Charles , Dowds Murdo M.
Published: April 2015

Fifty psychiatric inpatients aged 50 and over, with no hard neurologic findings, and with a variety of DSM‐III diagnoses (adjustment disorder, affective illness, and dementia), were rated for behavioral and psychiatric symptoms using the Geriatric Rating Scale and the Nurse's Assessment of Global Symptomatology‐Elderly. These clinical ratings were correlated with computed tomographic (CT) scan assessments of various superficial cerebral regions as well as with linear measures of ventricular size. Behavioral deficits in activities of daily living (AOL) plus an interactional variable, inability to respond to requests, were correlated with superior temporal and inferior parietal CT abnormalities, particularly on the left side. Suspiciousness and peculiar thinking, mood lability and irritability, as well as impaired memory with confusion, perplexity, and disorientation were also associated with atrophy in these same regions. Prefrontal area defects correlated with mood lability and deficits in visual‐interactional responsiveness. Statistically controlling for effects of age and alcohol abuse did not alter the basic nature of these results. Regional cerebral specialization in relation to these results are discussed using concepts developed by Luria. J Am Geriatr Soc 33:96, 1985
Psychiatric Assessment of Elderly Patients in the Home: A Survey of 176 Cases
Authors: Levy Michael T.
Published: April 2015

One hundred and seventy‐six homebound elderly patients referred for psychiatric evaluation by family, physician, or community agency were assessed in the home by a geriatrician psychiatrist, accompanied by those involved with the patient's care, whenever possible. Careful attention was paid to the interaction between psychiatric, medical, and social parameters and their collective effect on the aging patient. The most common discrete psychiatric diagnoses were dementia, with or without secondary symptoms; major depression; and paranoid states without dementia. Assessment resulted in home treatment and maintenance through a variety of supportive interventions frequently accompanied by chemotherapy, emergency psychiatric and medical hospitalization, and placement, as well as education of family and community workers. J Am Geriatr Soc 33:9, 1985
The Effect of Age on Blood Pressure in Hyperthyroidism
Authors: Saito Ikuo , Ito Kunihiko , Saruta Takao
Published: April 2015

To better define the effect of age on blood pressure in patients with hyperthyroidism, the blood pressures of 321 patients with hyperthyroidism were compared with those of 324 euthyroid controls. Subjects were divided into four age groups by decade from 20 to 59 years. The systolic, but not diastolic, blood pressure in the patients with hyperthyroidism was significantly higher in all age groups. Among the euthyroid controls, the systolic blood pressure increased with age. However, no age‐related increase was apparent among the hyperthyroid patients because of the relatively high systolic blood pressure in young patients. Effective antithyroid treatment reduced the systolic blood pressure significantly in hyperthyroid patients. The reduction of systolic blood pressure was greater in the younger hyperthyroid patients than that in the older ones, so that an age‐related increase in systolic blood pressure was present after a euthyroid state had been achieved. These results provide evidence against the report that in hyperthyroidism, hypertension tends to occur in older patients, and suggest that the effect of excessive thyroid hormone on the systolic blood pressure may differ according to age. J Am Geriatr Soc 33:19, 1985
The Effects of Terodiline and Meladrazine on Severe Motor Urge Incontinence in Geriatric Patients
Authors: Beisland Hans Olav , Fossberg Erling
Published: April 2015

Twenty‐five geriatric patients with severe motor urge incontinence were treated with terodiline and meladrazine separately and in combination. Because of poor general state of health and serious concomitant diseases the frequency of dropouts was high. Separate administration of the drugs improved the majority of the patients subjectively, but not sufficient for complete continence. Urodynamically, however, significant improvement was found only with terodiline. On combined administration with both drugs, seven of 15 patients became completely continent, seven were improved, and one remained unchanged, but additional urodynamic improvement was not demonstrated. Meladrazine caused a high incidence of side effects; therefore, treatment with terodiline separately is recommended for geriatric patients who have severe motor urge incontinence. J Am Geriatr Soc 33:29, 1985
Research in Nursing Homes
Authors: Cassel Christine K.
Published: April 2015

The growing need for care of elderly persons demands research in biomedical and clinical areas, as well as health services, social science, psychology, and ethics. There is a special urgency for research into the problems that affect persons needing long‐term care, and for research into the structures and patterns of the delivery of long‐term care. There are ethical issues in all aspects of human subjects experimentation, but the long‐term care setting raises specific ethical issues related to the dependency of the subjects and to the fact of institutionalization. Special considerations about equity, informed consent, the meaning of special protections, and confidentiality are among those needing attention. Research into these ethical issues can serve to enable better research, not simply to act as a barrier to research. Understanding the conceptual and historical bases of the special problems in long‐term care research will serve to further the understanding of how to improve long‐term care.
Acute Hospitalization in a Home for the Aged
Authors: Gordon W. Z. , Kane Robert L. ,   Rebecca Rothenberg, MSPH
Published: April 2015

All acute hospitalizations from a 229‐bed home for the aged for a four‐year period were analyzed. Of 373 residents eligible for the study, 239 individuals were hospitalized a total of 503 times. Five patients were admitted seven times. Median length of stay was 9.4 days. Of 235 primary diagnoses, only nine occurred at least 1% of the time. Sixty‐six different complications, representing 131 occurrences, were noted during hospitalization. Hospital mortality was 11.7%. Of first admissions 9.2% died and 19% of survivors required a higher level of care. One year later 40% had died and 17% were at a higher level of care. Logistic regression identified four variables significantly associated with death within six months of first hospitalization: age, hospital complication, surgical procedure, and diagnosis of acute myocardial infarction. Compared with nonhospitalized residents, hospitalized residents were more likely to be male, but no age effect was noted. Survival differences did not emerge until the third year of the study. J Am Geriatr Soc 33:519, 1985
Thyroid Disease in Patients With Dementia of the Alzheimer Type
Authors: Small Gary W. , Matsuyama Steven S. , Komanduri Ramanujam , Kumar Vinod , Jarvik Lissy F.
Published: April 2015

The authors compared the frequencies of prior thyroid disease, thyroid medication use, and abnormal serum thyroxine levels in 61 patients with dementia of the Alzheimer type (DAT) with those of 38 control subjects. They found that the 33 women with DAT had a 24.2% frequency of prior thyroid disease, comparable with that found in a previous epidemiologic study. The 19 female controls, however, had a similar frequency, failing to support a previously reported association between DAT and thyroid disease. J Am Geriatr Soc 33:538, 1985